adrenal%20insufficiency
ADRENAL INSUFFICIENCY
Adrenal insufficiency (AI) is the insufficient secretions of corticosteroids that may cause partial or complete destruction of the adrenal glands.
Primary AI or Addison’s disease is due to the inability of the adrenal gland to produce steroid hormones even when the stimulus by the pituitary gland via corticotrophin is adequate or increased.
Secondary AI is due to disorders of the pituitary gland that causes production of low levels of adrenocorticotropic hormone that will result to reduced cortisol levels.
Tertiary AI is the inability of the hypothalamus to produce sufficient amount of corticotropin releasing hormone.
Signs and symptoms are usually nonspecific with insidious onset.
Common signs and symptoms are fatigue, weakness, salt craving, orthostatic hypotension, nausea, vomiting, abdominal pain, diarrhea, anorexia and weight loss.

Patient Education

Patient should be instructed to carry card and warning bracelet/necklace with info about current therapy and emergency treatment recommendations

  • Patient should be taught of the nature of hormone deficiency and the rationale of steroid replacement therapy
  • Patient should be educated about glucocorticoid adjustments in stressful events and adrenal crisis prevention strategies

Steroid Replacement Therapy

  • Glucocorticoid therapy
    • Patient must be taught to double or triple their dose of glucocorticoid replacement temporarily if they have febrile illness or injury
    • If vomiting occurs soon after oral dose, patient should be instructed to take 2nd dose
    • Glucocorticoid injection should be provided for self-injection in cases of major injury, severe vomiting, acute adrenal insufficiency (AI), if the patient becomes unresponsive
  • Mineralocorticoid therapy
    • No need for patient to increase mineralocorticoid therapy during illness unless critically ill
    • Patients should be instructed to maintain adequate salt intake (3-4 g/day)
    • May need to increase dose of Fludrocortisone and to add extra salt to diet during hot weather, times of strenuous exercise, sweating, etc

History of Excessive Steroid Use

  • Educate patient about risks of excessive steroid use
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