Endocrine

Question 1

Treatment for Addison’s

Answer 1

Management is usually both glucocorticoid and mineralocorticoid replacement therapy –> this means give combo of hydrocortisone and fludrocortisone

Hydrocortisone –> patients typically require 20-30mg per day, with the majority given in the morning dose (roughly double this in intercurrent illness)

Question 2

Causes of Addisonian crisis

Answer 2

• sepsis or surgery causing an acute exacerbation of chronic insufficiency (addison’s, hypopituitarism)
• adrenal haemorrhage e.g. waterhouse-Friderichsen syndrome (fulminent meningococcesmia)
• Steroid withdrawal

Question 3

Management of Addisonian crisis

Answer 3

hydrocortisone 100 mg im or iv
1 litre normal saline infused over 30-60 mins or with dextrose if hypoglycaemic
continue hydrocortisone 6 hourly until the patient is stable. No fludrocortisone is required because high cortisol exerts weak mineralocorticoid action
oral replacement may begin after 24 hours and be reduced to maintenance over 3-4 days