Types
of adrenal steroids
·
Glucocorticoids: act on carbohydrate
metabolism
·
Mineralocorticoids: Na, K, and fluid
balance in distal kidney tubules
·
Androgens: converted to testosterone
Addison
disease (primary hypoadrenalism)
·
Causes:
autoimmune, infiltration, TB,
surgical removal, hemorrhage/infarction, infiltration
·
Effects:
Impaired glucocorticoid, mineralocorticoid,
and androgen production
· Symptoms: weight loss, anorexia, malaise, fever, weakness,
depression, impotence/amenorrhoea, nausea/vomiting, diarrhea, constipation,
confusion, syncope, abdominal pain, myalgia, joint pain
· Signs: pigmentation,
postural hypotension, weight loss, muscle wasting, dehydration, loss of body
hair
Cushing’s
syndrome (increased circulating glucocorticoids)
· Causes: (a) increased ACTH
from pituitary, ectopic tumors, or drug administration (b) adrenal adenoma /
carcinoma (c) iatrogenic glucocorticoid administration
·
Symptoms:
weight gain, changed appearance,
depression, insomnia, amenorrhea/oligomenorhea, poor libido, thin skin easy to
bruise, acne, muscle weakness, back pain, polyuria/polydipsia, psychosis
· Signs:
short stature, moon plethoric face,
depression/psychosis, acne, hirsuitism, thin bruising skin, poor wound healing,
pigmentation, skin infections, systemic hypertension, osteoporosis,
pathological fractures, Kyphosis due to osteoporosis, truncal / central obesity (buffalo hump),
abdominal striae, rib fractures, proximal muscle weakness
HISTORY
OF ADRENAL CONDITIONS (SCORING SHEET)
|
1
|
2
|
3
|
4
|
|
|
1.0 DEMOGRAPHIC
INFO
|
||||
|
Name
|
||||
|
Age
and date of birth
|
||||
|
Residential
address
|
||||
|
Occupation
|
||||
|
2.0 HISTORY
OF PRESENTING COMPLAINT(s)
|
||||
|
Complaint
#1: Onset, course, location (site), radiation, severity, time of day,
duration, diurnal variation, character, aggravating factors (food, cough etc
), relieving factors, associated symptoms
|
||||
|
Complaint
#2:
|
||||
|
Complaint
#3:
|
||||
|
Complaint
#4:
|
||||
|
What
does the patient think is going on?
|
||||
|
Treatments
already given
|
||||
|
Effect:
work, daily life, sports,
|
||||
|
3.0 PAST
MEDICAL / SURGICAL HISTORY
|
||||
|
Chronic
illnesses like HT, DM, Cardiac
|
||||
|
Hospitalizations
|
||||
|
Surgeries
|
||||
|
4.0
ALLERGY HISTORY
|
||||
|
Reactions
to medications: type and drug
|
||||
|
Food
allergies
|
||||
|
Environmental
allergies
|
||||
|
5.0
MEDICATION HISTORY
|
||||
|
List
of current medications doses and why: prescribed or OTC?
|
||||
|
List
of chronic medications
|
||||
|
Medicine
stopped
|
||||
|
Herbal
or complimentary medications
|
||||
|
6.0 FAMILY HISTORY
|
||||
|
Parents:
age, height, weight, health status, consanguinity, region of origin
|
||||
|
Siblings:
names, nicknames, age, height, weight, health status
|
||||
|
Significant
problems maternal & paternal sides:
arthritis, DM, HT, renal disease, anemia, headache, TB
|
||||
|
Diseases
that run in the family
|
||||
|
Specific
question about illnesses resembling presenting complaint: thyroid disease,
|
||||
|
7.0
SOCIAL HISTORY
|
||||
|
Type
of housing, location (city vs rural), how many people in house
|
||||
|
Education,
occupation, income, religion and culture, smoking
|
||||
|
Health
insurance
|
||||
|
Contact
with animals
|
||||
|
8.0
RISK FACTORS
|
||||
|
9.0
REVIEW OF SYSTEMS (If not covered in presenting complaints and PMH)
|
||||
|
Skin:
skin rash, pigmentation, bruising
|
||||
|
CVS
and RES: chest pain, cough (hemoptysis), dypnea (orthopnea, nocturnal dyspnea),
cyanosis, palpitations, ankle swelling,
|
||||
|
Hematological:
pallor, jaundice, bone pain, bruises, epsitaxis
|
||||
|
GIT:
Vomiting, nausea, dyspepsia, dysphagia, abd pain, diarhoea / constipation, Bowel
habits, feeding, weight loss / gain, rectal bleeding
|
||||
|
Urinary
tract: dysuria, enuresis, frequency., nocturia, hematuria, incontinence,
urethral discharge
|
||||
|
Genital:
menstruation (regularity, length, volume), impotence,
|
||||
|
CNS:
irritability, drowsiness, collapse / blackout, abnormal movements (seizures), headache,
numbness, dizziness and loss of balance, vision, hearing, headache
|
||||
|
Musculoskeletal:
joint swelling, joint pain, skin rash, movement restrictions, muscle wasting,
spasms,
|
