increased renin (eg, in RAS or renal hypoperfusion like CHF or hypovolemia)
Tx chronic primary AI: besides cortisol, must also tx insuff of:
aldosterone: Fludrocortisone; check for postural HypoTN, orthostasis, serum K, renin; poss inc dose summer (inc persp Na loss) & dec dose in HTN (do not d/c altogether); NO K sparing diuretics for anti-HTN Rx
Abd CT (esp of adrenals); Adrenal vein sampling: for localization (cath of left an&d right adrenal veins & the IVC, looking for lateralization of elevated aldosterone level
Wermer syndrome workup
Measure PTH & Ca levels. Image pancreas & pituitary
Androgen-secreting adrenal adenomas
Rare; high serum androgen conc remain elevated despite Dex suppression
Tx for aldosterone producing adenoma (APA):
surgical (effective only in patients with unilateral disease). Angioplasty if RAS.
Pheochromocytoma =
dz of adrenal medulla (site of catecholamine prodn)
Give pre-op hydrocortisone / continue 24 hrs; cut dose by 50% after first 24 h; cut dose by 50% each day until return to maint level (small procedures: give single dose of HC IV beforeprocedure)
