Adrenal Crisis

Adrenal crisis is an acute, life-threatening emergency that must be suspected and treated based upon clinical impression. It is due primarily to cortisol insufficiency and to a lesser extent, aldosterone insufficiency, and occurs when the physiologic demand for these hormones exceeds the capacity of the adrenal glands to produce them.

Adrenal reserve may be exhausted in patients with chronic adrenal insufficiency when they are subjected to intercurrent illness or stress. These patients should be taught to respond to minor febrile illness or stress by increasing their glucocorticoid dose by 2 to 3 times the usual dose for a few days during the illness. Mineralocorticoid dose does not need to be changed. During an emergency from severe trauma or stress, dexamethasone 4 mg IM can be self-administered. A variety of conditions may precipitate crisis; these include major or minor infections, trauma, surgery, burns, pregnancy, hypermetabolic states such as hyperthyroidism, and drugs, especially hypnotics or general anesthetics. Adrenal crisis may also occur in patients with chronic adrenal failure if the patient fails to or is unable to take replacement steroid medication. The most common cause of adrenal crisis is abrupt withdrawal of steroids from a patient with iatrogenic adrenal suppression due to prolonged steroid use. Finally, bilateral adrenal gland hemorrhage from fulminant septicemia or other causes can produce adrenal crisis.

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