• Adrenal Crisis

    (Acute Adrenocortical Insufficiency)

    Definition

    Adrenal crisis is a life-threatening condition. The anterior pituitary gland does not make enough adrenocorticotropic hormone (ACTH). ACTH is responsible for regulating the adrenal gland. The adrenal gland makes hormones that regulate many important bodily functions.
    Adrenal crisis is very serious. People with adrenal crisis require immediate treatment.
    Pituitary Gland
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    Adrenal Glands
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    Causes

    Adrenal crisis may be caused by:
    • Rapid withdrawal from steroid therapy
    • Sepsis (bloodstream infection)
    • Surgical stress
    • Adrenal apoplexy—bleeding into the adrenal glands
    • Pituitary necrosis (damage to pituitary tissue)
    • Thyroid hormone replacement in someone with adrenal insufficiency

    Risk Factors

    Factors that increase your chances of developing adrenal crisis include:
    • Septic shock
    • Adrenal insufficiency
    • Use of steroid medications

    Symptoms

    Adrenal Crisis may cause:
    • Weakness
    • Feeling tired all the time
    • Nausea
    • Vomiting
    • Loss of appetite
    • Weight loss
    • Low blood pressure
    • Abdominal pain
    • Fever
    • Confusion or coma
    • Diarrhea
    • Bluish skin color
    • Dehydration
    • Shock
    If you suspect an adrenal crisis, seek medical care immediately.

    Diagnosis

    Your doctor will ask about your symptoms and medical history. A physical exam will be done. Blood tests will be done to:
    • Measure hormone levels (ACTH, cortisol)
    • Examine red blood cells
    • Measure glucose electrolytes levels
    • Look for autoimmune or endocrine disorders
    Images of the glands or other structures may be needed. They may be taken with:
    An ACTH stimulation test may be done. This test measures ACTH after stimulation. It will help to confirm the diagnosis of adrenal insufficiency.

    Treatment

    Talk with your doctor about the best treatment plan for you. Treatment options include the following:

    Fluid Replacement

    Almost all patients with adrenal crisis are dehydrated. Large amount of fluids containing sodium and sugar will be needed.

    Medications

    Steroid and antibiotic medications are needed in an adrenal crisis. If you are vomiting or unconscious, these medications will be given by injection or through an IV.

    Prevention

    To help reduce your chances of having adrenal crisis, take the following steps:
    • See your doctor if you are always tired, feel weak, or have had unexplained weight loss. Your doctor can test for a shortage of adrenal hormones. Early treatment may prevent a crisis.
    • If you take hydrocortisone, prednisone, or dexamethasone, learn how to increase your dose if you become ill.
    • If you have adrenal gland problems and become ill (eg, nausea, vomiting), seek emergency medical care immediately.
    • If you have adrenal gland problems, make sure you have a dexamethasone injection with you at all times. Ensure that you and those around you know how to give the injection.
    • If you have adrenal insufficiency, carry a medical ID card. Wear a bracelet that tells emergency workers about your problem.

    RESOURCES

    American Association of Clinical Endocrinologists http://www.aace.com/

    Endocrine and Metabolic Diseases Information Service http://www.endocrine.niddk.nih.gov/

    CANADIAN RESOURCES

    Canadian Association of Emergency Physicians http://www.caep.ca/

    Canadian Institute for Health Information http://secure.cihi.ca/

    References

    Acute adrenocortical insufficiency. DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated May 2, 2012. Accessed December 31, 2012.

    Adrenocortical insufficiency and Addisons disease. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://www.endocrine.niddk.nih.gov/pubs/addison/addison.aspx . Updated April 6, 2012. Accessed December 31, 2012.

    Adrenal crisis causes death in some people treated with human growth hormone. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://www.endocrine.niddk.nih.gov/pubs/creutz/alert.htm . Accessed December 31, 2012.

    Bouillon R. Acute adrenal insufficiency. Endocrinol Metab Clin North Am . 2006;35:767-75.

    Omori K, Nomura K, Shimizu S, et al. Risk factors for adrenal crisis in patients with adrenal insufficiency. Endocrine J . 2003; 50:745-52.

    Thomas Z: an update on the diagnosis of adrenal insufficiency and the use of corticotherapy in critical illness. Ann Pharmacotherapy 2007:41:1456-65

    Todd GRG, Acerini CL, Ross-Russell R, et al. Survey of adrenal crisis associated with inhaled corticosteroids in the United Kingdom. Arch. Dis Child . 2002; 87:457-461.

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