Adrenal crisis is a potentially life-threatening medical condition requiring immediate emergency treatment. It is a constellation of symptoms (caused by insufficient levels of the
hormone cortisol
Cortisol is a steroid hormone, in the glucocorticoid class of hormones. When used as a medication, it is known as hydrocortisone.
It is produced in many animals, mainly by the ''zona fasciculata'' of the adrenal cortex in the adrenal gland ...
) that indicate severe adrenal insufficiency.
This may be the result of either previously undiagnosed or untreated
Addison's disease, a disease process suddenly affecting adrenal function (such as bleeding from the adrenal glands in
Waterhouse–Friderichsen syndrome), suddenly
stopping intake of glucocorticoids or an intercurrent problem (e.g. infection, trauma, in fact any form of physical or mental stress) in someone known to have Addison's disease,
congenital adrenal hyperplasia (CAH), or other form of primary adrenal insufficiency.
Signs and symptoms
Characteristic symptoms are:
* Sudden penetrating pain in the legs, lower back or abdomen
* Confusion,
psychosis, slurred speech
* Severe
lethargy
*
Convulsions
*
Fever
*
Hyperkalemia (elevated potassium level in the blood)
*
Hypercalcemia
Hypercalcemia, also spelled hypercalcaemia, is a high calcium (Ca2+) level in the blood serum. The normal range is 2.1–2.6 mmol/L (8.8–10.7 mg/dL, 4.3–5.2 mEq/L), with levels greater than 2.6 mmol/L defined as hypercalcemi ...
(elevated calcium level in the blood): the cause 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)
*
Hypothyroidism
Hypothyroidism (also called ''underactive thyroid'', ''low thyroid'' or ''hypothyreosis'') is a disorder of the endocrine system in which the thyroid gland does not produce enough thyroid hormone. It can cause a number of symptoms, such as po ...
(low T4 level)
* Severe
vomiting and
diarrhea, resulting in
dehydration
*
Syncope (transient loss of consciousness) and/or
orthostatic hypotension (drop in blood pressure on standing, leading to loss of balance)
Causes
Adrenal crisis is caused by a deficiency of
cortisol
Cortisol is a steroid hormone, in the glucocorticoid class of hormones. When used as a medication, it is known as hydrocortisone.
It is produced in many animals, mainly by the ''zona fasciculata'' of the adrenal cortex in the adrenal gland ...
resulting from
Addison's disease,
congenital adrenal hyperplasia (CAH), corticosteroid biosynthetic enzyme defects or
pituitary disorders (such as
Sheehan's syndrome,
pituitary adenoma,
hypopituitarism (inactive or underactive pituitary) causing failure to activate the adrenal glands. May also be a side effect of Zytiga (Abiraterone) for prostate cancer.
Diagnosis
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
Prevention
Adrenal crisis is triggered by physiological stress (such as
trauma) or severe psychological stress. Activities that have an elevated risk of trauma are best avoided. Treatment must be given within two hours of trauma and consequently it is advisable to carry injectable hydrocortisone in remote areas.
Hydrocortisone
The Pituitary Foundation, UK
Treatment
Acute adrenal insufficiency is a medical emergency and needs to be treated with injectable hydrocortisone and fluid support.
Epidemiology
Hahner et al. investigated the frequency, causes and risk factors for adrenal crisis in patients with chronic adrenal insufficiency.
See also
* Stress dose Perioperative stress dose of steroids to mitigate this rare but potentially fatal Complication (medicine), complications of perioperative use of steroid such as full-blown adrenal crisis in the perioperative period due to the secondary adrenal insuf ...
References
External links
Acute adrenal crisis
on PubmedHealth
Adrenal Crisis
on Patient.info
{{Shock types
Medical emergencies
Adrenal gland disorders