Adrenal Crisis

Question 1

What is an adrenal crisis?

Answer 1

Addisonian crisis is the term used to describe an acute presentation of severe Addisons, where the absence of steroid hormones leads to a life threatening presentation.

Question 2

What may precipitate an adrenal crisis?

Answer 2

Precipitated by intercurrent infection or stress.

Question 3

What are the signs and symptoms of an adrenal crisis?

Answer 3

• Reduced consciousness
• Hypotension
• Hypoglycaemia, hyponatraemia and hyperkaemia
• Patients can be very unwell

Question 4

What investigations should be ordered for an adrenal crisis?

Answer 4

Do not wait to perform investigations and establish a definitive diagnosis before treating someone with suspected Addisonian Crisis as this is life threatening and they need immediate treatment.

Question 5

Briefly describe the treatment of an adrenal crisis

Answer 5

• Intensive monitoring if unwell
• Parenteral steroids (i.e. IV hydrocortisone 100mg stat then 100mg every 6 hours)
• IV fluid resuscitation
• Correct hypoglycaemia
• Careful monitoring of electrolytes and fluid balance

Question 6

Why is fludocortisone not needed in an adrenal crisis?

Answer 6

Emergency administration of fludrocortisone is not required because high-dose hydrocortisone has a mineralocorticoid effect.