Adrenal crisis, or acute adrenal insufficiency, usually develops in patients with chronic adrenal insufficiency, including those who are properly treated. It is a life-threatening condition and therefore requires immediate medical intervention. What are the causes and symptoms of an adrenal crisis? How is the disease treated?

Adrenal crisis , i.e.acute adrenal insufficiency , is a state caused by decompensation, i.e. the depletion of adrenal cortex reserve forces (i.e. which so far compensated for the existing defect), as a result of which the chronic adrenal insufficiency exacerbates. Then it is not able to produce enough cortisol.

Adrenal crisis: causes

The cause of adrenal crisis is usually inadvertent discontinuation of steroid medications (mainly in the elderly). Other causes of adrenal crisis may include dehydration (as a result of massive vomiting or profuse diarrhea), systemic infections, adrenal gland trauma (e.g. in the course of surgery), exercise, and stress. These are the situations in which the demand for adrenal cortex hormones increases. Taking drugs such as ketoconazole, mitotane, phenytoin and rifampicin - due to their negative impact on the production and metabolism of adrenal cortex hormones - may also lead to adrenal crisis.

Acute adrenal insufficiency usually develops in patients with chronic adrenal insufficiency, including those who are properly treated, but it can also develop in people with severe systemic disease (e.g., meningococcal sepsis with disseminated intravascular coagulation - DIC, also known as Waterhouse syndrome. 'a-Friderichsen) who have had a bilateral adrenal infarction or are treated with anticoagulants.

In he althy people, adrenal crisis may be a consequence of antifungal treatment with ketoconazole (it is a strong inhibitor of adrenal steroidogenesis), and may be the first symptom of adrenal insufficiency (it usually occurs in patients with undiagnosed Addison's disease, i.e. primaryadrenal insufficiency) or neoplastic disease (metastases to the adrenal glands).

Adrenal crisis: symptoms

An adrenal crisis usually produces symptoms that predict the possibility of such a condition. Unfortunately, they are not specific and may rather indicate gastric disease or the flu, such as loss of appetite, nausea, headache, dizziness, weakness and general malaise. Then they are joined by other symptoms that indicate adrenal crisis, i.e .:

  • nausea, vomiting and diarrhea which may lead to dehydration
  • increasing feeling of weakness as a result of electrolyte disturbances
  • pain in the abdomen, sacrum, muscles and joints
  • fever
  • hypotension
  • orthostatic hypotension (blood pressure drop after standing)
  • disturbance of consciousness and difficulty in establishing contact that may lead to coma

Secondary adrenal crisis is additionally characterized by symptoms of chronic pituitary insufficiency, such as: a waxy face, no facial hair in men, dry and light skin, no hair, obesity, edema, and amenorrhea in women.

Important

Adrenal crisis is life threatening!

Adrenal crisis is an immediately life-threatening condition as it can lead to shock, cardiovascular collapse, multiple organ failure or sepsis. Therefore, when symptoms of adrenal crisis appear in a patient, an ambulance should be called as soon as possible.

Adrenal crisis: first aid and treatment

In the event of the above-mentioned symptoms, the paramedic or the doctor should collect some of the patient's blood as soon as possible for later tests (determination of cortisol and ACTH levels), and then administer hydrocortisone to the patient in the second vein. He should do so without waiting for the test results, as it is less of a mistake to administer hydrocortisone unnecessarily than not to have this type of procedure. Next, you should supplement the deficiencies of fluids and electrolytes (especially sodium) by administering a drip, i.e. infusion of saline and glucose. The patient requires hospitalization because hydrocortisone injections should be repeated.

Bibliography: Burska, K., Kluj P., Nowakowski M., Pre-hospital and early-hospital management in the states of sudden diseases of endocrine glands, "Anestezjologia i Ratownictwo" 2011, no. 5.

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He alth