Adrenal insufficiency: Difference between revisions

Latest revision as of 16:01, 6 March 2021

Differential Diagnosis

Inflammatory/Autoimmune
Infectious
- Tuberculosis
- Meningococcemia causing Waterhouse-Friderichsen syndrome
- HIV, CMV
- Histoplasmosis
Malignancy
- Metastases, especially breast cancer
Other
- Systemic anticoagulation
- Adrenoleukodystrophy

Management

Treat with dexamethasone while awaiting result of ACTH stimulation test to confirm diagnosis
- At 1h after ACTH, cortisol should be above 550 and have increased by 250
Stress dosing, to be given for 24h unless ongoing illness
- Hydrocortisone 300mg (divided q8h)
- Prednisone 60mg
- Methylprednisolone 50mg
- Dexamethasone 8mg
After stress dosing, can deescalate quickly to physiologic doses
- Prednisone 7.5mg daily or 5mg/2.5mg split, with fludrocortisone 0.1mg daily
- Hydrocortisone 20mg/10mg split, without fludrocortisone
For future stress dosing during intercurrent illnesses, can simply double dose when febrile

@@ Line 1: / Line 1: @@
-== Differential Diagnosis ==
+==Differential Diagnosis==
-* Inflammatory/Autoimmune
+*Inflammatory/Autoimmune
-** Primary autoimmune
+**[[Primary adrenal insufficiency|Primary (autoimmune) adrenal insufficiency]]
-** Sarcoidosis
+**[[Sarcoidosis]]
-** Antiphospholipid syndrome
+**[[Antiphospholipid syndrome]]
-* Infectious
+*Infectious
-** Tuberculosis
+**[[Tuberculosis]]
-** Meningococcemia causing Waterhouse-Friedrickson
+**[[Neisseria meningitidis|Meningococcemia]] causing [[Waterhouse-Friderichsen syndrome]]
-** HIV, CMV
+**[[HIV medications|HIV]], [[CMV in pregnancy|CMV]]
-** Histoplasmosis
+**[[Histoplasmosis]]
-* Malignancy
+*Malignancy
-** Metastases, especially breast cancer
+**[[Metastases]], especially [[breast cancer]]
-* Other
+*Other
-** Systemic anticoagulation
+**Systemic [[anticoagulation]]
-** Adrenoleukodystrophy
+**[[Adrenoleukodystrophy]]
-== Management ==
+==Management==
-* Treat with dexamethasone while awaiting result of ACTH stimulation test to confirm diagnosis
+*Treat with [[dexamethasone]] while awaiting result of ACTH stimulation test to confirm diagnosis
-** At 1h after ACTH, cortisol should be above 550 and have increased by 250
+**At 1h after ACTH, cortisol should be above 550 and have increased by 250
-* Stress dosing, to be given for 24h unless ongoing illness
+*Stress dosing, to be given for 24h unless ongoing illness
-** Hydrocortisone 300mg (divided q8h)
+**[[Hydrocortisone]] 300mg (divided q8h)
-** Prednisone 60mg
+**[[Prednisone]] 60mg
-** Methylprednisolone 50mg
+**[[Methylprednisolone]] 50mg
-** Dexamethasone 8mg
+**[[Dexamethasone]] 8mg
-* After stress dosing, can deescalate quickly to physiologic doses
+*After stress dosing, can deescalate quickly to physiologic doses
-** Prednisone 7.5mg daily or 5mg/2.5mg split, with fludrocortisone 0.1mg daily
+**[[Prednisone]] 7.5mg daily or 5mg/2.5mg split, with fludrocortisone 0.1mg daily
-** Hydrocortisone 20mg/10mg split, without fludrocortisone
+**[[Hydrocortisone]] 20mg/10mg split, without fludrocortisone
-* For future stress dosing during intercurrent illnesses, can simply double dose when febrile
+*For future stress dosing during intercurrent illnesses, can simply double dose when febrile
 [[Category:Endocrinology]]