Adrenal crisis
Adrenal crisis, also known as Addisonian crisis or acute adrenal insufficiency, is a serious, life-threatening complication of adrenal insufficiency. Hypotension, or hypovolemic shock, is the main symptom of adrenal crisis. Other symptoms include weakness, anorexia, nausea, vomiting, fever, fatigue, abnormal electrolytes, confusion, and coma. Laboratory testing may detect lymphocytosis, eosinophilia, hyponatremia, hyperkalemia, hypoglycemia, and occasionally, hypercalcemia.
| Adrenal crisis | |
|---|---|
| Other names | Acute adrenal insufficiency, Addisonian crisis, Acute adrenal failure. |
| 49-year-old with an adrenal crisis. Appearance, showing lack of facial hair, dehydration, Queen Anne's sign (panel A), pale skin, muscular and weight loss, and loss of body hair (panel B). | |
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| Specialty | Emergency medicine, Endocrinology |
| Symptoms | Dizziness, somnolence, confusion, loss of consciousness, nausea, vomiting, abdominal pain, decreased appetite, extreme exhaustion, unintended weight loss, weakness, and hypotension. |
| Complications | Seizures, arrhythmias, organ damage, coma, and death. |
| Causes | Adrenal insufficiency, thyrotoxicosis, infections, trauma, pregnancy, and surgery. |
| Risk factors | Adrenal insufficiency, polyglandular autoimmune syndromes, glucocorticoids, levothyroxine, and rifampin. |
| Diagnostic method | ACTH, basic metabolic panel, and cortisol. |
| Differential diagnosis | Myocardial infarction, trauma, stress, myxedema coma, circulatory shock, septic shock, and infection. |
| Prevention | Providing intramuscular hydrocortisone at home and using sick day rules. |
| Treatment | Steroid replacement and fluid resuscitation. |
| Medication | Hydrocortisone. |
| Prognosis | 6% mortality rate. |
| Frequency | 6–8% of those with adrenal insufficiency annually. |
The biggest trigger for adrenal crisis is gastrointestinal illness. The physiological mechanisms underlying an adrenal crisis involve the loss of endogenous glucocorticoids' typical inhibitory effect on inflammatory cytokines.
When a patient with adrenal insufficiency exhibits symptoms of an adrenal crisis, treatment should begin immediately. To diagnose an adrenal crisis, serum cortisol, aldosterone, ACTH, renin, and dehydroepiandrosterone-sulfate should be measured. A low cortisol level of less than 5 mg/dL (138 nmol/L), measured in the early morning or during a stressful period, suggests a diagnosis of adrenal insufficiency.
A tailored prescription, as well as a strategy for administering additional glucocorticoids for physiological stress, are critical preventative measures. When an adult experiences an adrenal crisis, they require immediate parenteral hydrocortisone.
About 6 to 8% of patients with adrenal insufficiency experience an adrenal crisis at some point each year. The mortality rate linked to adrenal crises is up to 6%.