Adrenal insufficiency: Difference between revisions
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| − | == |
+ | ==Differential Diagnosis== |
| − | * |
+ | *Inflammatory/Autoimmune |
| − | ** Primary autoimmune |
+ | **[[Primary adrenal insufficiency|Primary (autoimmune) adrenal insufficiency]] |
| − | ** |
+ | **[[Sarcoidosis]] |
| − | ** |
+ | **[[Antiphospholipid syndrome]] |
| − | * |
+ | *Infectious |
| − | ** |
+ | **[[Tuberculosis]] |
| − | ** Meningococcemia causing Waterhouse- |
+ | **[[Neisseria meningitidis|Meningococcemia]] causing [[Waterhouse-Friderichsen syndrome]] |
| − | ** HIV, CMV |
+ | **[[HIV medications|HIV]], [[CMV in pregnancy|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 |
[[Category:Endocrinology]] |
[[Category:Endocrinology]] |
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Latest revision as of 12:01, 6 March 2021
Differential Diagnosis
- Inflammatory/Autoimmune
- Infectious
- 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
