Adrenal Insufficiency

Adrenal Insufficiency (Addison disease): • Need 90% destruction of the adrenal gland to produce symptoms • primary (Addison's disease) is idiopathic adrenal insufficiency due to autoimmune destruction. causes both a gluco and a mineralocorticoid deficiency. • Hashimoto's thyroiditis in association with autoimmune adrenal insufficiency is termed Schmidt's syndrome. • Other: bacterial or fungal infections, metastatic cancer, sepsis and hemorrhage. • Secondary: anterior pituitary fails to secrete sufficient quantities of ACTH. from tumor, infection, surgical ablation, or radiation therapy.( less severe S/S, aldosterone is maintained • S/S→ Wt loss, muscle weakness, ↓BP, abd/back pain due bleeding, N&V, hyperpigmenation in primary only • Dx by ACTH stim test

A→ loose teeth B→ Resp muscle weakness C→ ↓BP, hypovolemia, ↓ response to catecholamines, arrhythmias with ↑K D→ ↑ sen to NDMR, avoid sux( ↑K), stress dose steroid, avoid etomidate M→ ↑K, ↓Na, hypoglycemia, Key issues: • Correct hypovolemia, and lytes • Stress dose steroid • Consider atr-line , PAC • Check lytes, glucose intra-op • Consider ICU post-op → Addisonian crisis/collapse more post-op