The Intern At Work: Internal Medicine

45. When Stress Alone Is Not Enough - Adrenal Insufficiency

9 snips
Jan 26, 2020
Dr. Franco, Dr. Luthra, and Dr. Srivaratharajah discuss adrenal insufficiency, covering causes, effects, diagnosis, and management. They explore historical cases, patient evaluation, triggers, workup, replacement therapy, adrenal crisis, and steroid dosage adjustments.
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ANECDOTE

John F. Kennedy's Addison's Disease

  • John F. Kennedy was diagnosed with Addison's disease and had almost no traces of adrenal glands at autopsy.
  • His condition was concealed during his presidency due to political concerns but marked a well-known example of adrenal insufficiency.
INSIGHT

HPA Axis and Cortisol Role

  • The hypothalamic-pituitary-adrenal axis regulates stress via hormones like CRH, ACTH, and cortisol.
  • Cortisol controls glucose, metabolism, blood pressure, and inflammation with a predictable circadian rhythm.
INSIGHT

Primary vs Secondary Adrenal Insufficiency

  • Primary adrenal insufficiency results from adrenal gland damage causing high ACTH levels.
  • Secondary adrenal insufficiency stems from pituitary problems, usually causing low or normal ACTH.
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