Definition: Acute adrenal crisis is an extreme life-threatening manifestation of adrenal insufficiency. It occurs secondary to interruption of a normal or hyperfunctioning adrenal or pituitary gland or sudden interruption of adrenal replacement therapy.
Adrenal insufficiency can be divided into 3 categories:
- chronic primary adrenal insufficiency (Addison disease)
- chronic secondary adrenal insufficiency
- and adrenal crisis (acute adrenal insufficiency).
- Autoimmune in 80 % of cases
- Infections (T.B. , HIV)
Chronic secondary adrenal insufficiency (-- ACTH)
caused by pituitary tumour
- Sudden withdrawal of chronic steroids usage (or secondary to stress)
- Adrenal hge (caused by,meningiococci-sepsis-warfarin therapy-coagulopathy)
- Pituitary dysfunction (sheehan syndrome)
- CNS lesions in rare cases
Clinical manifestations of adrenal crisis
- Unexplained hypotension (resistant to fluid and catecholamines)
- nonspecific symptoms such as anorexia, nausea, vomiting, abdominal pain, weakness, fatigue, lethargy, fever, confusion, or coma.
Immediate treatment of adrenal crisis should begin prior to laboratory confirmation (usually hyperkalemia,hyponatremia)
- Normal saline is the intravenous fluid of choice
- Stress-dose steroid replacement should be administered. Hydrocortisone may be administered as a 100-mg intravenous push followed by continuous infusion of 150-300 mg/day for 2 to 3 days
- Alternatively, dexamethasone as a 4-mg intravenous bolus may be administered instead of hydrocortisone to avoid interference with testing of cortisol levels
- Mineralocorticoid, namely fludrocortisone acetate, should also be administered at 0.1 mg daily.
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