Adrenal crisis
Life-threatening complication of adrenal insufficiency requiring immediate treatment.
Adrenal crisis, also known as Addisonian crisis or acute adrenal insufficiency, is a life-threatening complication of adrenal insufficiency. It is characterized by hypotension and hypovolemic shock as the main symptoms, along with weakness, anorexia, nausea, vomiting, fever, fatigue, abnormal electrolytes, confusion, and coma. The condition requires immediate treatment and is a significant cause of morbidity and mortality in those with adrenal insufficiency.
- field
- Endocrinology
- known_for
- Life-threatening complication of adrenal insufficiency
- mortality_rate
- Up to 6%
- annual_incidence
- 6–8% of those with adrenal insufficiency experience an adrenal crisis each year
- main_symptoms
- Hypotension and hypovolemic shock
Lore & Background
Adrenal crisis occurs when there is an absolute or relative lack of cortisol, leading to loss of the natural inhibitory function of glucocorticoids on inflammatory cytokines. This causes sharp rises in cytokine concentrations, inducing fever, lethargy, anorexia, and pain. Low cortisol also reduces vascular reactivity, causing vasodilatation and hypotension, and adversely affects liver metabolism, resulting in hypoglycemia and decreased gluconeogenesis. The biggest trigger for adrenal crisis is gastrointestinal illness, and those with primary adrenal insufficiency are at higher risk.
Reader's Guide
Adrenal crisis is a critical medical emergency that can be the first indication of Addison's disease in up to 50% of cases. Diagnosis is often delayed because symptoms are nonspecific and develop insidiously. The main signs are hypotension and shock that fail to respond to vasopressors or fluid resuscitation. Laboratory testing may show low sodium, high potassium, high lymphocyte count, high eosinophils, low blood sugar, and rarely high calcium. Treatment must begin immediately with parenteral hydrocortisone. Preventative measures include tailored prescriptions and strategies for administering additional glucocorticoids during physiological stress. The mortality rate linked to adrenal crises is up to 6%, and about 6–8% of those with adrenal insufficiency experience an adrenal crisis each year. A known precipitating event can be found in over 90% of episodes, with infections being the most common cause.
Did You Know?
- The biggest trigger for adrenal crisis is gastrointestinal illness.
- Those with primary adrenal insufficiency are at a higher risk for an adrenal crisis compared to those with secondary adrenal insufficiency.
- 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.
- Exogenous steroid use is the most frequent cause of adrenal insufficiency, and those who use steroids also run the risk of experiencing an adrenal crisis.
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