Adrenal insufficiency: pathophysiology, diagnosis and management

Addison’s disease is the common name used to refer to which of the following types of adrenal insufficiency?

The adrenal glands are divided in different layers, each responsible for the synthesis and secretion of specific adrenal hormones. Which layer is responsible for the synthesis and secretion of cortisol?

Cortisol has a wide range of metabolic and regulatory functions within the body. Which of the following is a regulatory function of cortisol?

You are reviewing patients in your GP practice who are on oral glucocorticoid therapy to identify those at risk of adrenal insufficiency as part of the surgery’s response to the national patient safety alert. Which of the following patients would potentially be at risk of adrenal insufficiency?

As well as glucocorticoids, there are other medicines which are associated with adrenal insufficiency. Which of the following pain medicines are associated with a risk of developing adrenal insufficiency?

In its latest guidelines, the National Institute for Health and Care Excellence (NICE) recommends that adrenal insufficiency should be considered in patients with unexplained hyperpigmentation, or when there is no other clinical explanation for the presence of a number of other signs and symptoms.

Which of the following is a potential symptom of adrenal insufficiency?

The short Synacthen test is considered the ‘gold standard’ diagnostic test for adrenal insufficiency. What is the mechanism of action of tetracosactide (Synacthen)?

You are required to review the results of outpatients who have undergone serum cortisol assays and short Synacthen tests at your hospital.

Which of the following results would indicate that a diagnosis of adrenal insufficiency is likely?

Several medicines can interfere with the accuracy of the tests used to diagnose adrenal insufficiency. Which of the following medicines is known to falsely elevate cortisol levels?

You are reviewing a patient who has been diagnosed with secondary adrenal insufficiency. Which of the following represents an appropriate initial treatment for this patient?

A patient with adrenal insufficiency presents in your chronic disease clinic and asks about the possibility of switching from standard to modified-release hydrocortisone.

Which of the following statements about modified release hydrocortisone is correct?

You are reviewing patients with adrenal insufficiency in your endocrine clinic as part of the department’s commitment to ongoing annual reviews in line with the current NICE guidelines.

Which of the following signs/symptoms might suggest that a patient is being under-replaced with glucocorticoids and need a dose increase?

You are running a group patient education session on adrenal insufficiency and a patient asks you about the sick day rules as he is uncertain about what to do in times of intercurrent illness.

Which of the following statements about temporarily increasing the doses of steroid replacement during times of physiological stress is correct?

Which of the following statements about the supply of emergency kits to patients with adrenal insufficiency is correct?

A patient contacts your community pharmacy asking for advice on the management of their adrenal insufficiency. They are feeling unwell and have just vomited approximately 15 minutes after taking this morning’s dose of hydrocortisone.

Which of the following is the most appropriate advice to give?