Addisons in afya

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Adrenal insufficiency - so low steroid production
Addisonian crisis - low BP and coma

hyperK, hypoNa, (also hyperCa)
Increased pigmentation (MSH is byproduct of ACTH)

diagnose via ...
early morning cortisol (9am) assess adrenal function
>500 likely, <100 unlikely
100-500 do short synacthen test - give synacthen (250mcg) and test Cortisol after 30 or 60 mins (should be 500-600), do ACTH at baseline (arrive in lab within 10 mins on ice)
ACTH helps distinguish primary and secondary
Also adrenal Abs, TB/HIV, CT, pituitary tests, PA, POF, Thyroid

''Treatment Mineralocorticoid and glucocorticoid'' (Hydrocortisone and Fludrocortisone)
Hydro is about 20-30mg/day in 2-3 divided doses, most in am.
Crisis may occur (esp if not adherent to sick day rules) - inc glucocorticoid if fever or vomit (double dose)
check for essential HT (10%)
drug interactions
Pt education is impt - Use steroid card / medic alert bracelet

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