Endocrine & metabolic · UKMLA & AKT
Adrenal insufficiency
A free high-yield preview for the UKMLA Applied Knowledge Test. Below are the key points to recognise adrenal insufficiency — the full SA Note notes add investigations, management, complications and 10 practice questions.
Key high-yield points
- Fatigue and weakness - most common presenting complaint; profound and disproportionate
- Hyperpigmentation - primary disease only; palmar creases, buccal mucosa, scars, pressure areas - driven by elevated MSH (shares POMC precursor with ACTH)
- Postural hypotension - aldosterone deficiency → sodium/volume depletion
- Hyponatraemia, hyperkalaemia, non-anion-gap metabolic acidosis - primary disease only (aldosterone loss)
- Hypoglycaemia - cortisol deficiency impairs gluconeogenesis
- Nausea, vomiting, weight loss, salt craving, reduced axillary/pubic hair in women
Hyperpigmentation is the key discriminator: present in primary (high ACTH → high MSH), absent in secondary (low ACTH). A 'tanned' patient who has not been in the sun = Addison's disease until proven otherwise.
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