Differentiating Secondary adrenal insufficiency from other diseases: Difference between revisions
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! colspan="14" |<big>Differentiating amongst adrenal insufficiencies</big> | ! colspan="14" |<big>Differentiating amongst adrenal insufficiencies</big> | ||
|- | |- | ||
|Chronic | |style="padding: 5px 5px; background: #DCDCDC;" align="center" |Chronic | ||
|'''[[Primary adrenal insufficiency|Primary adrenal]]''' | |style="padding: 5px 5px; background: #DCDCDC;" align="center" |'''[[Primary adrenal insufficiency|Primary adrenal]]''' | ||
'''[[Primary adrenal insufficiency|insufficiency]]/ [[Addison's disease]]''' | '''[[Primary adrenal insufficiency|insufficiency]]/ [[Addison's disease]]''' | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | + | | style="background: #F5F5F5; padding: 5px; text-align:center" | + | ||
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* [[Fludrocortisone]] - 0.1 to 0.2 mg PO q daily | * [[Fludrocortisone]] - 0.1 to 0.2 mg PO q daily | ||
|- | |- | ||
|Chronic | |style="padding: 5px 5px; background: #DCDCDC;" align="center" |Chronic | ||
|'''Secondary adrenal''' | |style="padding: 5px 5px; background: #DCDCDC;" align="center" |'''Secondary adrenal''' | ||
'''insufficiency''' | '''insufficiency''' | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" |± | | style="background: #F5F5F5; padding: 5px; text-align:center" |± | ||
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* [[Hydrocortisone]] -15 to 25 mg PO daily in 2 to 3 divided doses | * [[Hydrocortisone]] -15 to 25 mg PO daily in 2 to 3 divided doses | ||
|- | |- | ||
|Acute | |style="padding: 5px 5px; background: #DCDCDC;" align="center" |Acute | ||
|'''Acute adrenal insufficiency/ Acute [[adrenal crisis]]''' | |style="padding: 5px 5px; background: #DCDCDC;" align="center" |'''Acute adrenal insufficiency/ Acute [[adrenal crisis]]''' | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | ++ | | style="background: #F5F5F5; padding: 5px; text-align:center" | ++ | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | ± | | style="background: #F5F5F5; padding: 5px; text-align:center" | ± | ||
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! colspan="15" |'''<big>Differentiating Adrenal Insufficiency from other diseases</big>''' | ! colspan="15" |'''<big>Differentiating Adrenal Insufficiency from other diseases</big>''' | ||
|- | |- | ||
| | |style="padding: 5px 5px; background: #DCDCDC;" align="center" | | ||
|'''[[Adrenal hemorrhage]]/ Waterhouse Friderichsen syndrome''' | |style="padding: 5px 5px; background: #DCDCDC;" align="center" |'''[[Adrenal hemorrhage]]/ Waterhouse Friderichsen syndrome''' | ||
|orthostatic | |orthostatic | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | ± | | style="background: #F5F5F5; padding: 5px; text-align:center" | ± | ||
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* Treat the underlying cause | * Treat the underlying cause | ||
|- | |- | ||
| | |style="padding: 5px 5px; background: #DCDCDC;" align="center" | | ||
|'''[[Congenital Adrenal Hyperplasia|Congenital adrenal hyperplasia]] (CAH)''' | |style="padding: 5px 5px; background: #DCDCDC;" align="center" |'''[[Congenital Adrenal Hyperplasia|Congenital adrenal hyperplasia]] (CAH)''' | ||
|Normal to hypertension | |Normal to hypertension | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" |± | | style="background: #F5F5F5; padding: 5px; text-align:center" |± | ||
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* [[Fludrocortisone]] - 0.1 to 0.2 mg PO q daily | * [[Fludrocortisone]] - 0.1 to 0.2 mg PO q daily | ||
|- | |- | ||
| | |style="padding: 5px 5px; background: #DCDCDC;" align="center" | | ||
|'''[[Syndrome of inappropriate antidiuretic hormone]] ([[SIADH]])''' | |style="padding: 5px 5px; background: #DCDCDC;" align="center" |'''[[Syndrome of inappropriate antidiuretic hormone]] ([[SIADH]])''' | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" |– | | style="background: #F5F5F5; padding: 5px; text-align:center" |– | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" |– | | style="background: #F5F5F5; padding: 5px; text-align:center" |– | ||
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* Severe Hypertonic (3%) [[saline]] | * Severe Hypertonic (3%) [[saline]] | ||
|- | |- | ||
| | |style="padding: 5px 5px; background: #DCDCDC;" align="center" | | ||
|'''Salt-depletion nephritis/ Salt losing nephropathy''' | |style="padding: 5px 5px; background: #DCDCDC;" align="center" |'''Salt-depletion nephritis/ Salt losing nephropathy''' | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | + | | style="background: #F5F5F5; padding: 5px; text-align:center" | + | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | – | | style="background: #F5F5F5; padding: 5px; text-align:center" | – | ||
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* [[Fludrocortisone]] - 0.05 to 0.2 mg PO q daily | * [[Fludrocortisone]] - 0.05 to 0.2 mg PO q daily | ||
|- | |- | ||
| | |style="padding: 5px 5px; background: #DCDCDC;" align="center" | | ||
|[[Anorexia nervosa|'''Anorexia nervosa''']] | |style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Anorexia nervosa|'''Anorexia nervosa''']] | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | + | | style="background: #F5F5F5; padding: 5px; text-align:center" | + | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | – | | style="background: #F5F5F5; padding: 5px; text-align:center" | – |
Revision as of 18:00, 3 October 2017
Adrenal insufficiency Microchapters |
Diagnosis |
---|
Treatment |
Case Studies |
Differentiating Secondary adrenal insufficiency from other diseases On the Web |
American Roentgen Ray Society Images of Differentiating Secondary adrenal insufficiency from other diseases |
FDA on Differentiating Secondary adrenal insufficiency from other diseases |
CDC on Differentiating Secondary adrenal insufficiency from other diseases |
Differentiating Secondary adrenal insufficiency from other diseases in the news |
Blogs on Differentiating Secondary adrenal insufficiency from other diseases |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].
OR
[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].
Adrenal Insufficiency
Acute/
Chronic |
Disease | Clinical history/findings | Causes | Laboratory findings | Medical therapy | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
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 | ||||||||||||||
Chronic | Primary adrenal | + | + | + | + | + | + |
|
+ | Low | Cosyntropin/ ACTH stimulation test |
| ||
Chronic | Secondary adrenal
insufficiency |
± | – | + | + | – | ± |
|
|
– | Normal | Cosyntropin/ ACTH stimulation test |
|
|
Acute | Acute adrenal insufficiency/ Acute adrenal crisis | ++ | ± | + | + | + | ± |
|
+ | Normal to Low | Cosyntropin/ ACTH stimulation test |
|
| |
Differentiating Adrenal Insufficiency from other diseases | ||||||||||||||
Adrenal hemorrhage/ Waterhouse Friderichsen syndrome | orthostatic | ± | + | ± | + | – |
|
+ | Normal to low | Cosyntropin/ ACTH stimulation test |
|
| ||
Congenital adrenal hyperplasia (CAH) | Normal to hypertension | ±
(can be indicator of Uncontrolled CAH)[6] |
– | – | – | – |
|
|
± | Low | Cosyntropin/ ACTH stimulation test |
|
| |
Syndrome of inappropriate antidiuretic hormone (SIADH) | – | – | – | – | – | – |
|
+ | Normal | Water deprivation test |
|
| ||
Salt-depletion nephritis/ Salt losing nephropathy | + | – | – | – | + Flank pain | – | ++[9] | High | Genetic study | <15:1 BUN:CR |
| |||
Anorexia nervosa | + | – | + | + | – | + |
|
– | High | Psychiatric condition | – |
|
References
- ↑ Patnaik MM, Deshpande AK (2008). "Diagnosis--Addison's disease secondary to tuberculosis of the adrenal glands". Clin Med Res. 6 (1): 29. doi:10.3121/cmr.2007.754a. PMC 2442022. PMID 18591375.
- ↑ Bhattacharjee R, Sharma A, Rays A, Thakur I, Sarkar D, Mandal B, Mookerjee SK, Chatterjee SK, Chowdhury PR (2013). "Addison's disease presenting with muscle spasm". J Assoc Physicians India. 61 (9): 675–6. PMID 24772716.
- ↑ Ray A, Sanyal D (2016). "A rare case of Addison's disease due to bilateral adrenal histoplasmosis presenting with hypoglycaemia". J Assoc Physicians India. 64 (1): 45–46. PMID 27727656.
- ↑ Choudhary N, Aggarwal I, Dutta D, Ghosh AG, Chatterjee G, Chowdhury S (2013). "Acquired perforating dermatosis and Addison's disease due to disseminated histoplasmosis: Presentation and clinical outcomes". Dermatoendocrinol. 5 (2): 305–8. doi:10.4161/derm.22677. PMC 3772918. PMID 24194970.
- ↑ Schimke KE, Greminger P, Brändle M (2009). "Secondary adrenal insufficiency due to opiate therapy - another differential diagnosis worth consideration". Exp. Clin. Endocrinol. Diabetes. 117 (10): 649–51. doi:10.1055/s-0029-1202851. PMID 19373753.
- ↑ Patel FB, Newman SA, Norton SA (2016). "Addisonian-Like Hyperpigmentation as an Indicator of Uncontrolled Congenital Adrenal Hyperplasia". Skinmed. 14 (1): 53–4. PMID 27072733.
- ↑ Seyberth HW (2016). "Pathophysiology and clinical presentations of salt-losing tubulopathies". Pediatr. Nephrol. 31 (3): 407–18. doi:10.1007/s00467-015-3143-1. PMID 26178649.
- ↑ Sayin B (2015). "Tacrolimus-Induced Salt Losing Nephropathy Resolved After Conversion to Everolimus". Transplant Direct. 1 (9): e37. doi:10.1097/TXD.0000000000000538. PMC 4946484. PMID 27500237.
- ↑ Yoshioka K, Nishio M, Sano S, Sakurai K, Yamagami K, Yamashita Y (2009). "Development of Severe Hyponatremia due to Salt-Losing Nephropathy after Esophagectomy for Esophageal Cancer". Case Rep Med. 2009: 241283. doi:10.1155/2009/241283. PMC 2771150. PMID 19888422.