<<forEachTiddler where 'tiddler.tags.contains(context.inTiddler.title)' sortBy tiddler.title ascending write '"*[["+tiddler.title+"]]\n"'>> <<tiddler AutoRefresh with: force>> 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