Adrenal crisis

Adrenal crisis
Other names	Acute adrenal insufficiency, Addisonian crisis, Acute adrenal failure.[1]
49-year-old male with an adrenal crisis. Appearance, showing lack of facial hair, dehydration, Queen Anne's sign (panel A), pale skin, muscular and weight loss, and loss of body hair (panel B).
Pronunciation	/əˈdriː.nəl ˈkraɪ.sɪs/
Specialty	Emergency medicine, Endocrinology
Symptoms	Dizziness, somnolence, confusion, loss of consciousness, nausea, vomiting, abdominal pain, decreased appetite, extreme exhaustion, unintended weight loss, weakness, and hypotension.[2]
Complications	Seizures, arrhythmias, organ damage, coma, and death.[2]
Causes	Adrenal insufficiency, thyrotoxicosis, infections, trauma, pregnancy, and surgery.[2]
Risk factors	Adrenal insufficiency, polyglandular autoimmune syndromes, glucocorticoids, levothyroxine, and rifampin.[2]
Diagnostic method	ACTH, basic metabolic panel, and cortisol.[2]
Differential diagnosis	Myocardial infarction, trauma, stress, myxedema coma, circulatory shock, septic shock, and infection.[2]
Prevention	Providing intramuscular hydrocortisone at home and using sick day rules.[2]
Treatment	Steroid replacement and fluid resuscitation.[3]
Medication	Hydrocortisone.
Prognosis	6% mortality rate.[4]
Frequency	6–8% of those with adrenal insufficiency annually.

Adrenal crisis, also known as Addisonian crisis or acute adrenal insufficiency, is a life-threatening complication of adrenal insufficiency. Hypotension, and hypovolemic shock, are the main symptoms of adrenal crisis. Other symptoms include weakness, anorexia, nausea, vomiting, fever, fatigue, abnormal electrolytes, confusion, and coma. Laboratory testing may detect low sodium (hyponatremia), high potassium (hyperkalemia), high lymphocyte count (lymphocytosis), high eosinophils (eosinophilia), low blood sugar (hypoglycemia), and rarely high calcium (hypercalcemia).

The biggest trigger for adrenal crisis is gastrointestinal illness. Those with primary adrenal insufficiency are at a higher risk for an adrenal crisis. The physiological mechanisms underlying an adrenal crisis involve the loss of endogenous glucocorticoids' typical inhibitory effect on inflammatory cytokines.

When someone with adrenal insufficiency exhibits symptoms of an adrenal crisis, treatment must begin immediately. To diagnose an adrenal crisis, serum cortisol, aldosterone, ACTH, renin, and dehydroepiandrosterone sulfate are measured. A low cortisol level of less than 3 mg/dL, measured in the early morning or during a stressful period, suggests a diagnosis of adrenal insufficiency.

A tailored prescription, and strategies for administering additional glucocorticoids for physiological stress, are critical preventative measures. When someone experiences an adrenal crisis, they require immediate parenteral hydrocortisone.

About 6–8% of those with adrenal insufficiency experience an adrenal crisis at some point each year. The mortality rate linked to adrenal crises is up to 6%.