64) ADRENOCORTICAL INSUFFICIENCY

[Editor]

a) causes a reduction in serum sodium concentration
b) is associated with hyperpigmentation
c) should be covered with perioperative steroids
d) is pathological of sheehans syndrome
e) causes increased plasma lipid levels

[Editor]

TTTFT

Adrenocortical insufficiency may be due to PRIMARY (Addison’s disease-autoimmune or TB, amyloidosis, metastases, haemorrhage, infarction or drugs) or SECONDARY (corticosteroid therapy withdrawal, ACTH deficiency due to surgery, head injury, tumours, infarction of the pituitary or hypothalamus) adrenal failure.
Mineralocorticoid deficiency leads to:
-loss of sodium and water causing dehydration and hypotension (including postural)
-elevated plasma potassium
-retention of H+ producing metabolic acidosis
Glucocorticoid deficiency leads to:
-weight loss, muscle weakness, hypoglycaemia, reduced resistance to trauma and infection
Hyperpigmentation may occur as melanocyte stimulating hormone is secreted in conjuction with ACTH.
Adequate steroid replacement therapy is necessary to avoid peri-operative haemodynamic instability in adrenocortical insufficiency. Complications may otherwise arise as a result of the underlying disease or from a potentially impaired stress response due to hypothalamic-pituitary-adrenal (HPA) suppression.
Sheehans Syndrome is pituitary necrosis after post partum haemorrhage. It is characterized by varying degrees of anterior pituitary dysfunction and GH is one of the earliest hormones lost.
Adrenocortical insufficiency is associated with high levels of very long chain fatty acids (VLCFA).