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Sir really helpful.. Should we treat subclinicle hypothyroidism if positive family history of autoimmune diseases?? 2nd.. one of my patient was taking 150ug thyroxine for overt hypothyroidism ... Now presentes after 2year with signs thyrotoxicosis ...what approach should be used ??? For how long thyroxine should be stopped?? Or we should use block and replace regimen??
🎯 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
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?
