Professional Documents
Culture Documents
Primary Secondary
• Infection like adrenalitis • Pituitary abnormality
• tuberculosis • Congenital ACTH deficiency
• Autoimmune adrenalitis • Hypothalamic abnormality
• Adrenal infiltration
• Metastasis sarcoidosis
• Bilateral adrenalectomy
Pathophysiology
Sign and symptoms
INTEGUMENTARY SYSTEM
• Delayed wound healing.
• Dry and itchy skin (in women)
• Skin hyperpigmentation (primary adrenal insufficiency)
• Alabaster-coloured pale skin (secondary adrenal insufficiency)
• Loss of axillary or pubic hair (in women),
• Absence of adrenarche or pubarche in children
CARDIO VASCULAR SYSTEM
• Low blood pressure (systolic RR < 100 mm Hg),
• postural hypotension (pronounced in primary adrenal insufficiency)
• Tachycardia.
• Arrhythmias
MUSCULOSKELETAL SYSTEM
• Myalgia,
• Weakness.
• Joint Pain.
• Muscle wasting.
• reduced muscle strength
GASTRO INTESTINAL SYSTEM
• Anorexia.
• Diarrhea.
• Nausea & Vomiting.
• Gastric pain
REPRODUCTIVE SYSTEM
• Menstrual changes.
• Loss or impairment of libido (in women)
METABOLIC CHANGES
• Hyperkalemia.
• Hypoglycemia.
• Hyponatremia.
• Hypercalcemia
• Raised serum creatinine
OTHER SIGN AND SYMPTOMS
• Fever
• lack of energy or stamina,
• weight loss (in children failure to thrive)
• Salt craving
• Anaemia,
• lymphocytosis,
• Eosinophilia
• Increased thyroid stimulating hormone
ADRENAL CRISIS
• Sudden, severe worsening of adrenal insufficiency symptoms
is called adrenal crisis.
• If the person has Addison’s disease, this worsening can also
be called an Addisonian crisis.
SIGN AND SYMPTOMS
When the response to the ACTH test is abnormal, a CRH stimulation test
can help determine the cause of adrenal insufficiency.
In this test, the patient is given an IV injection of synthetic CRH, and
blood is taken before and 30, 60, 90, and 120 minutes after the injection.
The cortisol levels in the blood samples are measured.
If Addison’s disease responds by producing high levels of
ACTH, yet no cortisol.
If secondary adrenal insufficiency does not produce ACTH or
have a delayed response.
CRH will not stimulate ACTH secretion if the pituitary is
damaged, so no ACTH response points to the pituitary as the
cause.
A delayed ACTH response points to the hypothalamus as the
cause.
• Blood glucose levels.
• BUN level.
• Urinary 17 hydroxy corticoids & 17 Ketosteroids levels.
• CT scan of head.
• Abdominal CT & X-Ray
• Ultrasound of the abdomen
• Tuberculin skin test
• Antibody blood tests
MEDICAL MANAGEMENT
Intervention-
• Assess skin turgor and mucous membranes for signs of dehydration
• Assess vital signs, especially noting BP and HR for orthostatic changes.
• Assess colour, concentration, and amount of urine.
• Assess trends in weight.
2- Risk for imbalanced nutrition less than body requirements related
to loss of appetite and decreased oral intake.
Intervention-
• Continue monitor patient’s weight.
• Suggest need for frequent small meals.
• Encourage for bed rest.
• Assess for salt craving.
3- Risk for injury related to extreme weakness.
Goal- reduce the risk of injury.
Intervention-
• Assess the base line data.
• Educate for avoid alone journey
• Educate for proper rest
COMPLICATIONS FROM ADRENAL CRISIS