Sandbox:Amd: Difference between revisions
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! colspan="7" |Clinical history/findings | ! colspan="7" |Clinical history/findings | ||
! rowspan="2" |Causes | ! rowspan="2" |Causes | ||
! colspan=" | ! colspan="4" |Investigations/ | ||
Laboratory findings | Laboratory findings | ||
!Medical management | !Medical management | ||
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!Cortisol levels | !Cortisol levels | ||
!Gold Standard | !Gold Standard | ||
!Other | |||
! | ! | ||
! | ! | ||
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! colspan=" | ! colspan="15" |<big>Differentiating amongst adrenal insufficiencies</big> | ||
|- | |- | ||
|'''Primary adrenal''' | |'''Primary adrenal''' | ||
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|↓ | |↓ | ||
|Cosyntropin/ ACTH stimulation test | |Cosyntropin/ ACTH stimulation test | ||
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'''insufficiency''' | '''insufficiency''' | ||
|± | |± | ||
| | | – | ||
|✔ | |✔ | ||
|✔ | |✔ | ||
| | |– | ||
| | |± | ||
| | | | ||
* [[Hypoglycemia]] (more than primary adrenal insufficiency) | * [[Hypoglycemia]] (more than primary adrenal insufficiency) | ||
* Signs of pituitary tumor- [[Headache]], visual field defects ( [[bitemporal hemianopsia]]) | * Signs of pituitary tumor- [[Headache]], visual field defects ([[bitemporal hemianopsia]]) | ||
| | | | ||
* [[Hypopituitarism]]- Tumors, infections. hemorrhage/trauma | * [[Hypopituitarism]]- Tumors, infections. hemorrhage/trauma | ||
* Drugs- Chronic [[steroid]] therapy and its withdrawal, [[Opiates]] | * Drugs- Chronic [[steroid]] therapy and its withdrawal, [[Opiates]] | ||
* [[Genetics|Genetic]]- Combined pituitary hormone deficiency (CPHD), [[POMC]] ([[Proopiomelanocortin]]) gene deficiency | * [[Genetics|Genetic]]- Combined pituitary hormone deficiency (CPHD), [[POMC]] ([[Proopiomelanocortin]]) gene deficiency | ||
| | |– | ||
|Normal | |Normal | ||
|Cosyntropin/ ACTH stimulation test | |Cosyntropin/ ACTH stimulation test | ||
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* Tumor | * Tumor | ||
|✔ | |✔ | ||
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* I/V 0.9% saline 1-3 liters within 12-24 hours | * I/V 0.9% saline 1-3 liters within 12-24 hours | ||
* I/V Dexamethasone 4 mg bolus, ''or,'' I/V hydrocortisone 50 mg bolus | * I/V Dexamethasone 4 mg bolus, ''or,'' I/V hydrocortisone 50 mg bolus | ||
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! colspan=" | ! colspan="15" |'''<big>Differentiating Adrenal Insufficiency from other diseases</big>''' | ||
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Revision as of 16:16, 26 September 2017
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Amandeep Singh M.D.[2]
Adrenal Insufficiency
| Disease | Clinical history/findings | Causes | Investigations/
Laboratory findings |
Medical management | Surgical management | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Hypotension | Skin
pigmentation/ findings |
Fatigue | Anorexia/
Weightloss |
Abdominal pain | Muscle
weakness |
Other history/
findings |
Hypo
natremia |
Cortisol levels | Gold Standard | Other | ||||
| Differentiating amongst adrenal insufficiencies | ||||||||||||||
| Primary adrenal
insufficiency |
✔ | ✔ | ✔ | ✔ | ✔ | ✔ |
|
✔ | ↓ | Cosyntropin/ ACTH stimulation test | ||||
| Secondary adrenal
insufficiency |
± | – | ✔ | ✔ | – | ± |
|
|
– | Normal | Cosyntropin/ ACTH stimulation test | |||
| Acute adrenal insufficiency | ↓↓ | ± | ✔ | ✔ | ✔ | ± |
|
|
✔ |
|
||||
| Differentiating Adrenal Insufficiency from other diseases | ||||||||||||||