Clinical Features

The clinical manifestations of adrenal crisis are due primarily to insufficiency of cortisol and, to a lesser extent, insufficiency of aldosterone. Patients appear acutely ill. They are profoundly weak and may be confused. Hypotension, especially postural hypotension, is usual. Circulatory collapse may be profound. The pulse is feeble and rapid, and heart sounds may be soft. Temperature elevation is common but may be due to underlying infection. Anorexia, nausea, vomiting, and abdominal pain are almost universal. The abdominal pain may be severe, simulating an acute abdomen. Patients in crisis may exhibit increased motor activity which can progress to delirium or seizures.

Laboratory findings vary. The serum sodium level is usually moderately decreased but may be normal. Potassium levels may be normal or slightly increased. Rarely the potassium concentration may be markedly increased, and this can cause cardiac dysrhythmias or hyperkalemic paralysis. Hypoglycemia is characteristic and can be severe.

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