How do diagnose and Treat Adrenal insufficiency in primary care practice ?

[@koustubhti]

Nice and very well compiled. Keep enlightening us🙏🙏🙏

[@syedriyazahmad9047]

Quite informative and well explained by Dr O J L. Thank you

[@Snigdhwala]

Sir 🙏🏻🙏🏻
Take class on type 1 diagnosis nd management
Plzzz sirrr🙏🏻🙏🏻

[@applebee4129]

Yes pls

[@srinivasaraosirasapalli5104]

So nice doctor, really thankful for case based scenarios

[@EndocrinologyIndia]

🎯 Key points for quick navigation:
00:01 *📋 Introduction and Importance of Adrenal Insufficiency*
- Adrenal insufficiency is a critical condition, often overlooked.
- It can be a life-and-death matter if untreated.
- Misdiagnosis is common, but recognition and treatment are straightforward.
02:18 *📚 Basics of Adrenal Insufficiency*
- Overview of the Hypothalamic-Pituitary-Adrenal (HPA) Axis.
- Explanation of hormone releases: CRH from the hypothalamus, ACTH from the pituitary, and cortisol from the adrenal glands.
- Cortisol’s role in stress response and its negative feedback mechanism.
05:37 *🏥 Types of Adrenal Insufficiency*
- Primary adrenal insufficiency: Issues with the adrenal glands.
- Secondary adrenal insufficiency: Pituitary gland problems.
- Tertiary adrenal insufficiency: Hypothalamus-related issues.
- Examples of conditions and surgeries leading to each type.
08:43 *💊 Drug-Induced Adrenal Insufficiency*
- Medications can cause primary, secondary, or tertiary adrenal insufficiency.
- Examples: Ketoconazole, Eplerenone, Rifampicin, steroids, narcotics, and anabolic steroids.
- Emphasis on steroids and their impact on the HPA axis.
11:14 *🔬 Diagnosing Adrenal Insufficiency*
- Importance of morning serum cortisol levels.
- Interpretation: Less than 3 μg/dL indicates insufficiency, 3-5 μg/dL is indeterminate, more than 5 μg/dL is likely normal.
- Follow-up tests include DHEA-S levels and ACTH stimulation test.
15:07 *📈 Evaluating the HPA Axis*
- Understanding cortisol and DHEA-S levels.
- Using age-specific DHEA-S values to determine adrenal insufficiency.
- Ratio analysis: DHEA-S value divided by the age-specific lower limit to assess adrenal function.
23:08 *🌬️ Non-Oral Steroids and Adrenal Insufficiency*
- Inhaled steroids can cause adrenal insufficiency due to systemic absorption.
- Intra-articular steroids can potentially cause adrenal insufficiency.
- Management strategies for adrenal insufficiency in different settings, such as acute adrenal crisis and chronic conditions.
26:31 *🧪 Case Studies Illustrating Adrenal Insufficiency*
- First case: A patient with exogenous Cushing syndrome and tertiary adrenal insufficiency.
- Signs include moonlike face, striae, and low morning cortisol.
- Importance of recognizing steroid abuse and proper history-taking in diagnosis.
32:13 *🏥 Recognizing Secondary Adrenal Insufficiency*
- Second case: A patient with a history of pituitary surgery leading to adrenal insufficiency.
- Symptoms include hyponatremia and a low response to ACTH stimulation test.
- Emphasis on cortisol testing and understanding pituitary surgery’s impact.
37:59 *🔍 Primary Adrenal Insufficiency and APS Type 2*
- Third case: A patient with significant weight loss, skin darkening, and hypothyroidism.
- Diagnosis of autoimmune polyendocrine syndrome (APS) type 2.
- Typical lab findings: low cortisol, high ACTH, hyponatremia, and hyperkalemia.
41:11 *📝 Summary and Key Takeaways*
- Key indicators for suspecting adrenal insufficiency: unexplained weight loss, darkening of skin, hyponatremia, and hypotension.
- Importance of baseline cortisol and DHEA-S testing.
- Referral to endocrinologists for confirmed adrenal insufficiency cases.
Made with HARPA AI

[@mustafaalishah8469]

Brother also make vdeos on CAH, AIS, and DSDs ,plz make it

[@PrasantaDatta-f3g]

Useful and interesting discussion. Thank you so much. Should we give replacement dose of glucocorticoid at at a time in the morning or in divided doses?

[@EndocrinologyIndia]

If you are using oral hydrocortisone then 10 in the morning and 5 mg at 5 pm

[@PrasantaDatta-f3g]

@@EndocrinologyIndia Thank you.

[@syedriyazahmad9047]

Are steroids addictive also ?

[@EndocrinologyIndia]

Yes