Patient Education - Endocrine Encyclopedia
Endocrine Surgery Encyclopedia
Definition:
Acute adrenal crisis is a life-threatening state caused by insufficient levels of
cortisol, which is a hormone produced and released by the adrenal gland.
Alternative Names: Adrenal crisis; Addisonian crisis; Acute adrenal insufficiency
Causes, incidence, and risk factors:
The two adrenal glands are located on top of the kidneys. They consist of the outer
portion, called the cortex, and the inner portion, called the medulla. The cortex
produces three types of hormones, all of which are called corticosteroids.
Cortisol is a glucocortoid, a corticosteroid that maintains glucose (blood sugar)
regulation, suppresses the immune response, and is released as part of the body's
response to stress. Cortisol production is regulated by a small gland just below
the brain called the pituitary gland. Cortisol is essential for life.
Acute adrenal crisis is a medical emergency caused by a lack of cortisol. Patients
may experience lightheadedness or dizziness, weakness, sweating, abdominal pain,
nausea and vomiting, or even loss of consciousness.
Adrenal crisis occurs if the adrenal gland is deteriorating (Addison's disease,
primary adrenal insufficiency), if there is pituitary gland injury (secondary adrenal
insufficiency), or if adrenal insufficiency is not adequately treated.
Risk factors for adrenal crisis include physical stress such as infection, dehydration,
trauma, or surgery, adrenal gland or pituitary gland injury, and ending treatment
with steroids such as prednisone or hydrocortisone too early.
Symptoms:
- Headache
- Profound weakness
- Fatigue
- Slow, sluggish movement
- Nausea
- Vomiting
- Low blood pressure
- Dehydration
- High fever
- Shaking chills
- Confusion or coma
- Darkening of the skin
- Rapid heart rate
- Joint pain
- Abdominal pain
- Unintentional weight loss
- Rapid respiratory rate (see tachypnea)
- Unusual and excessive sweating on face and/or palms
- Skin rash or lesions may be present
- Flank pain
- Loss of appetite
Signs and tests:
- An ACTH (cortrosyn) stimulation test shows low cortisol.
- The baseline cortisol level is low.
- Fasting blood sugar may be low.
- Serum potassium is elevated ( usually primary adrenal insufficiency).
- Serum sodium is decreased (usually primary adrenal insufficiency).
Treatment:
In adrenal crisis, an intravenous or intramuscular injection of hydrocortisone (an
injectable corticosteroid) must be given immediately. Supportive treatment of low
blood pressure with intravenous fluids is usually necessary. Hospitalization is required
for adequate treatment and monitoring. If infection is the cause of the crisis, antibiotic
therapy may be needed.
Support Groups:
Expectations (prognosis):
Death may occur due to overwhelming shock if early treatment is not provided.
Complications:
Calling your health care provider:
Call your health care provider if you have Addison's disease and are unable to retain
usual medications because of vomiting.
Go to the emergency room or call the local emergency number (such as 911) if symptoms
of acute adrenal crisis develop.
Prevention:
People who have Addison's disease should be taught to recognize signs of potential
stress that may cause an acute adrenal crisis. Most people with Addison's disease
are taught to give themselves an emergency injection of hydrocortisone or increase
their dose of oral prednisone in times of stress.
It is important for the individual with Addison's disease to always carry a medical
identification card that states the type of medication and the proper dose needed
in case of an emergency.
Never omit medication. If unable to retain medication due to vomiting, notify
the health care provider.
Review Date: 5/12/2006
Reviewed By: Robert Hurd, MD, Department of Biology, College of Arts and Sciences,
Xavier University, Cincinnati, OH. Review provided by VeriMed Healthcare Network.
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