Adrenal crisis
Medical emergency due to insufficient steroid production / From Wikipedia, the free encyclopedia
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.[8] Laboratory testing may detect lymphocytosis, eosinophilia, hyponatremia, hyperkalemia, hypoglycemia, and occasionally, hypercalcemia.[9]
The biggest trigger for adrenal crisis is gastrointestinal illness.[10] The physiological mechanisms underlying an adrenal crisis involve the loss of endogenous glucocorticoids' typical inhibitory effect on inflammatory cytokines.[9]
When a patient with adrenal insufficiency exhibits symptoms of an adrenal crisis, treatment should begin immediately.[11] To diagnose an adrenal crisis, serum cortisol, aldosterone, ACTH, renin, and dehydroepiandrosterone sulfate should be measured.[8] A low cortisol level of less than 5 μg/dl (138 nmol/L), measured in the early morning or during a stressful period, suggests a diagnosis of adrenal insufficiency.[12]
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.[13]
About 6–8% of patients with adrenal insufficiency experience an adrenal crisis at some point each year.[7] The mortality rate linked to adrenal crises is up to 6%.[6]