Adrenal Crisis

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Adrenal Crisis

• Nicole Wilde
• UNC Morning Report
• 5/18/10

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Adrenal Crisis Acute Adrenal Insufficiency

• Primary Adrenal Insufficiency
• Serious infection
• Acute stress in previously undiagnosed cases
• No extra glucocorticoid therapy during infection
• Abrupt withdrawal from glucocorticoids
• Bilateral adrenal infarction
• Bilateral adrenal Hemorrhage

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Signs/Symptoms

• Shock
• Anorexia
• Nausea/Vomiting
• Abdominal Pain
• Weakness/Fatigue
• Fever
• Confusion/Coma

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Bilateral Adrenal Hemorrhage or Infarction

• Before CT was diagnosed on autopsy
• Look for hyperkalemia, hyponatremia, and occult
  hemorrhage
• Risk Factors
• Anticoagulant therapy
• Coagulopathy
• Post operative State
• Meningococcemia or Pseudmonas (sepsis)

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Pituitary Apoplexy

• Adrenal crisis is rare with pituitary or
  hypothalamic adrenal insufficiency
• Hypovolemia rare due to normal Renin-agiotensin-al
  dosterone system
• Crisis can occur with Pituitary infarct
• Acute cortisol deficiency

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Chronic 1 Adrenal Insufficiency

• Glucocorticoid, mineralocorticoid, and androgen
  deficiency (women)
• Dehydration
• Hyperpigmentation
• Hyperkalemia
• Secondary and Tertiary adrenal insufficiency have
  normal mineralocorticoid function

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Diagnosis

• Random Cortisol
• Acute ACTH Stimulation Test
• Determine cause CT abdomen, MRI Head, Rule out
  sepsis, look for autoimmune disease, etc.

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Treatment

• Treat Hypotension
• Reversal of Electrolyte Abnormalities
• IVF
• Dexamethasone if measuring cortisol
• Hydrocortisone for no biochemical tests
• Fludocortisone

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The End