Adrenal crisis or insufficiency is a life threatening emergency due to the lack of glucocorticoid. Adrenal crisis can be primary due to destruction of the adrenal cortex (Addison’s), or secondary due to down regulation (chronic steroid use)

Signs/Symptoms

• Brain: Fatigue, Confusion, Reduced GCS
• CVS: Hypotension, Syncope, Arrhythmia (hyperkalaemia)
• GIT: Abdo pain, Diarrhoea, Vomiting, Weight loss
• Fever
• Skin: Hyper-pigmentation (primary), Pale (secondary)

Tests

• Acidosis
• Hyperkalaemia
• Hyponatraemia
• Hypercalcaemia (primary)
• Low Glucose
• Raised Ur & Cr
• (Send TFT’s as hyperthyroidism can precipitate)

Treatment (of crisis)

• Hydrocortisone 100mg IV (will then need need maintenance 50mg every 6hr)
• NaCl 0.9% 500ml over 15min (may need 3-4l in the 1st day, so close monitoring required)
• Treat electrolyte disturbance

Prevention

• Unwell with: fever, bed rest, antibiotics – Double the steroids (make sure they have enough)
• Vomiting – will need IV

Society of Endocrinology – Adrenal Crisis

PDF:Adrenal Crisis

Searchs: hyperkalemia, addisons, addisonian