UpToDate 2017

UpToDate
2017
 Type I AIPGS: adrenal
insufficiency,
hypoparathyroidism,
mucocutaneous
candidiasis.
Type II AIPGS: adrenal
insufficiency,
autoimmune thyroid
disease, and DM1.

Diabetes insipidus is often

present.
 CMDT 2017
UpToDate 2017
Symptom Frequency (%)
Weakness, tiredness, fatigue 100
Anorexia 100
Gastrointestinal symptoms 92
- Nausea 86
- Vomiting 75
- Constipation 33
- Abdominal pain 31
- Diarrhea 16
Salt craving 16 UpToDate
Postural dizziness 12
2017
Muscle or joint pains 6-13
Sign Frequency (%)
Weight loss 100
Hyperpigmentation 94
Hypotension (<110 mm Hg systolic) 88-94
Vitiligo 10-20
Auricular calcification 5
UpToDate
2017
Laboratory Finding Frequency (%)
Electrolyte disturbances 92
- Hyponatremia 88
- Hyperkalemia 64
- Hypercalcemia 6
Azotemia 55
UpToDate
Anemia 40 2017
Eosinophilia 17
 IAP Vs. IAST
IAST: no
hiperpigmentacin,
no deshidratacin,
no hiperkalemia,
hipotensin menos
prominente,
sntomas GI menos
comunes.
La hipoglucemia es
ms comn en la
IAST.
UpToDate 2017
 EMERGENCY MEASURES
Draw blood for serum electrolytes, glucose, and plasma cortisol and
ACTH.
Infuse 2-3 L of NS or 5% Dw.
Inject IV hydrocortisone (100 mg immediately and every 6-8 hr)
Use supportive measures as needed.
SUBACUTE MEASURES AFTER STABILIZATION OF THE PATIENT
Continue intravenous NS at a slower rate for next 24-48h.
Search for and treat possible infectious precipitating causes of the adrenal crisis.
Perform a short ACTH stimulation test to confirm the diagnosis of adrenal
insufficiency, if patient does not have known adrenal insufficiency.
Determine the type of adrenal insufficiency and its cause if not already known.
Taper glucocorticoids to maintenance dosage over 1-3 days, if precipitating or
complicating illness permits.
Begin mineralocorticoid replacement with fludrocortisone (0.1 mg by mouth daily)
when saline infusion is stopped.
 MAINTENANCE THERAPY
Glucocorticoid Replacement
Hydrocortisone 15-20 mg on awakening and 5-10 mg in early afternoon.
Monitor clinical symptoms and morning plasma ACTH.
Mineralocorticoid Replacement
Fludrocortisone 0.1 (0.05-0.2) mg orally.
Liberal salt intake.
Monitor lying and standing blood pressure and pulse, edema, serum potassium,
and plasma renin activity.
Educate patient about the disease, how to manage minor illnesses and major
stresses, and how to inject steroid intramuscularly.
 TREATMENT OF MINOR FEBRILE ILLNESS OR STRESS
Increase glucocorticoid dose 2-fold to 3-fold for the few days of
illness; do not change mineralocorticoid dose.
No extra supplementation is needed for most uncomplicated,
outpatient dental procedures under local anesthesia.
General anesthesia or intravenous sedation should not be used in the
office.