+ This lecture was conducted during the Nephrology Unit Grand Ground by Medical Student rotated under Nephrology Division under the supervision and administration of Prof. Jamal Al Wakeel, Head of Nephrology Unit, Department of Medicine and Dr. Abdulkareem Al Suwaida. Nephrology Division is not responsible for the content of the presentation for it is intended for learning and /or education purpose only.
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+ This lecture was conducted during the Nephrology Unit Grand Ground by Medical Student rotated under Nephrology Division under the supervision and administration.
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+This lecture was conducted during the Nephrology Unit Grand Ground by Medical Student rotated under Nephrology Division under the supervision and administration of Prof. Jamal Al Wakeel, Head of Nephrology Unit, Department of Medicine and Dr. Abdulkareem Al Suwaida. Nephrology Division is not responsible for the content of the presentation for it is intended for learning and /or education purpose only.
+Clinical manifestations of chronic adrenal insufficiency
symptoms Frequency
Weakness, tiredness, fatigue 100
Anorexia 100
Gastrointestinal symptoms 92
Postural dizziness 6 -13
Muscle or joint pains 12
+Clinical manifestations of chronic adrenal insufficiencySign Frequency, percent
Weight loss 100
Hyperpigmentation 94
Hypotension (systolic BP <110 mmHg)
88-94
Vitiligo 20
+
+Clinical manifestations of chronic adrenal insufficiencyLaboratory abnormality Frequency
Hyponatremia 88
Hyperkalemia 64
Hypercalcemia 6
Azotemia 55
Anemia 40
Eosinophilia 17
+Diagnosis :
Random Plasma Cortisol: usually low
Acth Stimulation Test (short Synacthen test): 250 μg ACTH1-24 (Synacthen) by i.m. injection at any time
of day Blood samples: 0 and 30 minutes for plasma cortisol Normal subjects plasma cortisol> 460 nmol/l Inadrenal insufficiencycortisol level fail to increase.
Then see ACTH: high ((primary)) , low ((secondary))
Plasma renin and aldosterone
+Treatment:
Glucocorticoid replacement : Cortisol (hydrocortisone) is the drug of choice . 15 -25 mg/day in 2-3 divided does 2/3 in morning , 1/3 afternoon