Addisonian crisis (acute adrenal crisis)
About Addisonian crisis (acute adrenal crisis)
A medical emergency where the adrenal gland does not make enough of the hormone cortisol. Cortisol is essential and helps maintain blood pressure, normal heart function, glucose metabolism, carbohydrate metabolism, protein metabolism, fat metabolism, and normal emotional well-being. The adrenal gland is located on top of the kidneys in the abdomen. Adrenal crisis occurs when patients with Addison's disease become stressed such as with an infection, after an injury, or during a surgery. There are two types of Addison's disease (adrenal insufficiency), primary and secondary. In primary the adrenal gland is damaged usually from an autoimmune disease, other causes include infections, cancer and bleeding into the gland. Secondary adrenal insufficiency occurs when the pituitary gland in the brain does not produce enough adrenocorticotropic hormone (ACTH). ACTH tells the adrenal gland to produce cortisol. In secondary adrenal insufficiency the adrenal gland itself is normal. The most common cause of secondary disease is taking steroids. Any other problem that damages the pituitary gland such as cancer, infection or surgery can also cause the secondary form of the disease.Symptoms
Back pain, confusion, coma, fainting, lightheaded with standing, fever, low blood pressure, faint pulse, fast heart rate, rapid breathing, slow sluggish movements, darkening of the skin (hyperpigmentation).Tests & Diagnostics
A history and physical will be done. Blood tests to measure the sodium, potassium, glucose, cortisol and ACTH levels will be done. CT scans and/or MRIs may be performed to look for damage to the adrenal or pituitary gland. An ACTH stimulation test is sometimes performed to measure the functioning of the adrenal gland.Common tests: Complete blood count (CBC), Comprehensive metabolic panel (CMP), CT Scan, MRI.
Conventional treatment summary
Patients need immediate treatment and admission to the hospital. Specific treatment includes: intravenous saline solutions, glucose, and intravenous hydrocortisone. For your more information contact the National Adrenal Diseases Foundation at www.nadf.us.Medical specialties
Internal Medicine · Diabetes, Endocrinology and Metabolism · Pediatric Endocrinology
This page is educational content, not medical advice. Always consult a qualified clinician for diagnosis and treatment of Addisonian crisis (acute adrenal crisis).