|Classification and external resources|
Adrenal crisis (also known as Addisonian crisis, Acute adrenal insufficiency) is a constellation of symptoms that indicate severe adrenal insufficiency caused by insufficient levels of cortisol. This may be the result of either previously undiagnosed or untreated Addison's disease, a disease process suddenly affecting adrenal function (such as adrenal hemorrhage in Waterhouse-Friderichsen syndrome), suddenly stopping intake of glucocorticoids, or an intercurrent problem (e.g. infection, trauma) in someone known to have Addison's disease. It is a medical emergency and potentially life-threatening situation requiring immediate emergency treatment.
It is caused due to deficiency of cortisol. Cortisol deficiency may be due to Addison's disease or corticosteroid biosynthetic enzyme defects.
Signs and Symptoms
Characteristic symptoms are:
- Sudden penetrating pain in the legs, lower back or abdomen
- Confusion, psychosis, slurred speech
- Severe lethargy
- Hyperkalemia (elevated potassium level in the blood)
- Hypercalcemia (elevated calcium level in the blood): the etiology of hypercalcemia is a combination of increased calcium input into the extracellular space and reduced calcium removal by the kidney, this last caused by decreased glomerular filtration and increased tubular calcium reabsorption. Both renal factors are secondary to volume depletion and, in fact, improve rapidly during rehydration with saline infusion.
- Hypoglycemia (reduced level of blood glucose)
- Hyponatremia (low sodium level in the blood)
- Hypotension (low blood pressure)
- Hypothyroid (low T4 level)
- Severe vomiting and diarrhea, resulting in dehydration
- Syncope (loss of consciousness and ability to stand)
Various investigations aid the diagnosis.
- ACTH (cosyntropin) stimulation test
- Cortisol level (to assess the level of glucocorticoids)
- Fasting blood sugar
- Serum potassium (to assess the level of mineralocorticoids)
- Serum sodium
Adrenal crisis is triggered by stress and hence people with adrenal insufficiency need to avoid stressful situations.
Hahner et al. investigated the frequency, causes and risk factors for adrenal crisis in patients with chronic adrenal insufficiency. Annane et al.'s landmark 2002 study found a very high rate of relative adrenal insufficiency among the enrolled patients with septic shock.
- "Acute adrenal crisis (Addisonian crisis)". Endocrine Surgery Encyclopedia. UCLA Health System. Retrieved 14 August 2013.
- "Addison's Disease". National Endocrine and Metabolic Diseases Information Service. Retrieved 14 August 2013.
- Hahner, S.; Loeffler, M.; Bleicken, B.; Drechsler, C.; Milovanovic, D.; Fassnacht, M.; Ventz, M.; Quinkler, M.; Allolio, B. (2 December 2009). "Epidemiology of adrenal crisis in chronic adrenal insufficiency: the need for new prevention strategies". European Journal of Endocrinology 162 (3): 597–602. doi:10.1530/EJE-09-0884. PMID 19955259.
- Annane, D. (20 August 2002). "Effect of Treatment With Low Doses of Hydrocortisone and Fludrocortisone on Mortality in Patients With Septic Shock". JAMA: the Journal of the American Medical Association 288 (7): 862–871. doi:10.1001/jama.288.7.862. PMID 12186604.
- Acute adrenal crisis on PubmedHealth
- Adrenal Crisis on Patient.co.uk
- Katherine White (28 July 2004). "What to do in an emergency -Addisonian crisis". Addison's Disease Self Help Group (ADSHG).
- Addisonian crisis on rightdiagnosis.com