Primary And Secondary Adrenal Insufficiency

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Adrenal Insufficiency This paper describes the differences between primary and secondary adrenal insufficiency. As health care providers it is important to be able to distinguish between the two and to know how to treat the patient. It is also imperative that an acute adrenal crisis can be recognized. This paper will discuss how to recognize and treat adrenal insufficiency.
Primary adrenal insufficiency Primary adrenal insufficiency occurs when the adrenal glands fail to release glucocorticoids and mineralocorticoids, despite the release of adrenocorticotrophic hormone (ACTH) from the pituitary, and may be fatal if untreated (Griffing, 2015). Margulies (2015) describes primary adrenal insufficiency, also known as Addison’s disease, as
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& Hamrahian, A.H., 2010). Other clinical and laboratory manifestations of primary adrenal insufficiency are presented in Table 1.
A medical history is very important if the patient has any symptoms mentioned above, especially hyperpigmentation of the skin or gums, it is often enough to raise a strong suspicion, prompting the appropriate tests. The following tests are appropriate to order to diagnose adrenal insufficiency: Serum chemistry, abnormalities are present in as many as 56% of patients. Hyponatremia is common although not diagnostic; hyperkalemia, metabolic acidosis, and hypoglycemia also may be present. However, the absence of laboratory abnormalities does not exclude the diagnosis of adrenal crisis. Serum cortisol, less than 20 mcg/dL in severe stress or after ACTH stimulation is indicative of adrenal insufficiency. ACTH test which is diagnostic, determine baseline serum cortisol, then administer ACTH 250 mcg intravenous push (IVP), and then draw serum cortisol 30 and 60 minutes after ACTH administration. An increase of less than nine mcg/dL is considered diagnostic of adrenal insufficiency. CBC, anemia mild and nonspecific, lymphocytosis, and eosinophilia highly suggestive may be present. Serum thyroid levels, assess for
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