by McCoy K

Adrenal Crisis

(Acute Adrenocortical Insufficiency)

Definition

Adrenal crisis is a life-threatening condition. It is caused by a deficiency of a hormone called cortisol. Cortisol helps to keep the body in balance with influence over blood sugar levels, immune system, blood pressure, and more.
Cortisol is made in the adrenal glands which sit just above the kidney. However, the pituitary gland, which sits just below the brain, regulates how much cotrisol should be made.
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—a bloodstream infection
  • Surgical stress
  • Injury to the adrenal gland or surgical removal of adrenal gland
  • Damage to pituitary gland from hemorrhage (bleeding), infarction, surgery, or trauma
  • Thyroid hormone replacement in someone with adrenal insufficiency

Risk Factors

Factors that increase your chances of developing adrenal crisis include:
  • Septic shock
  • Adrenal insufficiency
  • Chronic or frequent use of steroid medications
  • Tuberculosis or other granulomatous diseases
  • History of multiple autoimmune glandular diseases
  • HIV
  • Anti-coagulation therapy

Symptoms

Adrenal crisis may cause:
  • Weakness
  • Lightheadedness
  • Feeling excessively tired
  • Nausea and vomiting
  • Loss of appetite
  • Weight loss
  • Abdominal pain
  • High or low body temperature
  • Confusion
  • Diarrhea

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done. If the doctor suspects an adrenal crisis, the diagnosis will be confirmed through blood tests to look for abnormal levels of hormones, electrolytes, and blood sugar.
Images of pituitary or adrenal glands may be taken with an MRI or CT scan.

Treatment

Adrenal crisis is a very serious and potentially life threatening. People with adrenal crisis require immediate medical care.
Talk with your doctor about the best treatment plan for you. Treatment will include the following:

Fluid Replacement

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

Medications

Glucocorticoid replacement is 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 diagnosis and treatment may prevent a crisis.
  • If you take hydrocortisone, prednisone, or dexamethasone, learn how to increase your dose if you become ill. Do not stop these medications without talking to your doctor.
  • If you have adrenal gland problems and become ill, seek emergency medical care right away.
  • If you have adrenal gland problems, make sure you have a steroid 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://www.cihi.ca

References

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. Published September 24, 2012. Accessed June 4, 2014.

Adrenal insufficiency and Addison's disease. National Endocrine and Metabolic Diseases Information Service website. Available at: http://www.endocrine.niddk.nih.gov/pubs/addison/addison.aspx. Updated May 14, 2014. Accessed June 4, 2014.

Adrenal insufficiency in adults. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated December 16, 2013. Accessed June 4, 2014.

Omori K, Nomura K, et al. Risk factors for adrenal crisis in patients with adrenal insufficiency. Endocrine J. 2003; 50:745-752.

Thomas Z: an update on the diagnosis of adrenal insufficiency and the use of corticotherapy in critical illness. Ann Pharmacotherapy. 2007:41:1456-1465

Todd GRG, Acerini CL, 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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