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Adrenal crisis
| Clinical Discipline(s)/Organ System(s) Endocrinology, Clinical Biochemistry | Progress Test Topic(s) Homeostasis |
Description
A 45 year old NZ European man presents to his GP as he has been feeling very unwell for some time. He feels dizzy when he stands up, has lost weight and a cousin who has not seen him for a year has commented that his skin is becoming darker.
Progress Test-Type Questions: Question 1 | Question 2Applied Science for Medicine
- Anatomy of the adrenal glands
- Hormones secreted by the adrenal glands; mechanism of action of adrenal hormones
- Physiology of the hypothalamic-pituitary-adrenal axis
- Regulation of plasma potassium, sodium and implications of disturbance
- Difference between primary, secondary and tertiary adrenal insufficiency
- Pharmacology of synthetic hormones: dexamethasone, prednisone, fludrocortisone and hydrocortisone. Relative potencies of these drugs
- Principles of exogenous steroid use leading to endogenous adrenal suppression
- Anatomy of the adrenal glands
- Hormones secreted by the adrenal glands; mechanism of action of adrenal hormones
- Physiology of the hypothalamic-pituitary-adrenal axis
- Regulation of plasma potassium, sodium and implications of disturbance
- Difference between primary, secondary and tertiary adrenal insufficiency
- Pharmacology of synthetic hormones: dexamethasone, prednisone, fludrocortisone and hydrocortisone. Relative potencies of these drugs
- Principles of exogenous steroid use leading to endogenous adrenal suppression
Clinical and Communication Skills
- Consider risk factors for adrenal disease and other autoimmune conditions; causes of adrenal insufficiency
- Elicit a history from a fatigued patient
- Examine the fatigued patient; recognise the hyperpigmentation of Addison's disease
- Recognise blood test results that suggest Addison's disease; interpret short Synacthen test
- Describe the autoimmune polyglandular syndromes
- Management of adrenal insufficiency
- Define Addisonian crisis and outline the possible presenting features
- Management of Addisonian crisis
- Changes in dosage for those on long-term steroids during intercurrent stress or illness
- Consider risk factors for adrenal disease and other autoimmune conditions; causes of adrenal insufficiency
- Elicit a history from a fatigued patient
- Examine the fatigued patient; recognise the hyperpigmentation of Addison's disease
- Recognise blood test results that suggest Addison's disease; interpret short Synacthen test
- Describe the autoimmune polyglandular syndromes
- Management of adrenal insufficiency
- Define Addisonian crisis and outline the possible presenting features
- Management of Addisonian crisis
- Changes in dosage for those on long-term steroids during intercurrent stress or illness
Personal and Professional Skills
- Patient fears about hormone treatments
- Patient and family/whānau education about being responsible for their disease and altering doses, including medic alert bracelet
- Managing patient's ideas, concerns and expectations particularly in the context of unproven alternative therapies
- Dealing with non-specific presentations and recognising red flags
- Coping with uncertainty
- Time mananagement of a more complex presentation in short GP consultation
- Patient fears about hormone treatments
- Patient and family/whānau education about being responsible for their disease and altering doses, including medic alert bracelet
- Managing patient's ideas, concerns and expectations particularly in the context of unproven alternative therapies
- Dealing with non-specific presentations and recognising red flags
- Coping with uncertainty
- Time mananagement of a more complex presentation in short GP consultation
Population Health
- Epidemiology of Addison's disease and tuberculosis
- Epidemiology of Addison's disease and tuberculosis
Conditions to be considered relating to this scenario
Common
Addison's disease, autoimmune adrenitis, autoimmune polyglandular syndrome types 1 and 2, exogenous adrenal suppression, tuberculosis
Addison's disease, autoimmune adrenitis, autoimmune polyglandular syndrome types 1 and 2, exogenous adrenal suppression, tuberculosis
Less common but 'important not to miss'
amyloidosis, congenital adrenal hypoplasia, congenital adrenal hyperplasia, metastases
amyloidosis, congenital adrenal hypoplasia, congenital adrenal hyperplasia, metastases
Uncommon
adrenoleukodystrophy, Waterhouse-Friderichsen syndrome, ketoconazole use
adrenoleukodystrophy, Waterhouse-Friderichsen syndrome, ketoconazole use
