Return to Diagnosis ListShow Learning Points most relevant to Phase 1:

Adrenal crisis

Clinical Discipline(s)/Organ System(s)
Endocrinology, Clinical Biochemistry
Progress Test Topic(s)
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 2
Applied 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
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
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
Population Health 
   - Epidemiology of Addison's disease and tuberculosis
Conditions to be considered relating to this scenario
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
adrenoleukodystrophy, Waterhouse-Friderichsen syndrome, ketoconazole use
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