Adrenal crisis

Adrenal crisis, also known as Addisonian crisis or acute adrenal insufficiency, is a life-threatening complication of adrenal insufficiency. Hypotension and hypovolemic shock are the main symptoms of an adrenal crisis. Other symptoms include weakness, anorexia, nausea, vomiting, fever, fatigue, abnormal electrolytes, confusion, and coma. Laboratory testing may detect low sodium, high potassium, high lymphocyte count, high eosinophils, low blood sugar, and rarely high calcium. The biggest trigger for adrenal crisis is gastrointestinal illness. Those with primary adrenal insufficiency are at a higher risk for an adrenal crisis. The physiological mechanisms underlying an adrenal crisis involve the loss of endogenous glucocorticoids' typical inhibitory effect on inflammatory cytokines.

When someone with adrenal insufficiency exhibits symptoms of an adrenal crisis, treatment must begin immediately. To diagnose an adrenal crisis, serum cortisol, aldosterone, ACTH, renin, and dehydroepiandrosterone sulfate are measured. A low cortisol level of less than 3 mg/dL, measured in the early morning or during a stressful period, suggests a diagnosis of adrenal insufficiency. A tailored prescription, and strategies for administering additional glucocorticoids for physiological stress, are critical preventative measures. When someone experiences an adrenal crisis, they require immediate parenteral hydrocortisone. About 6–8% of those with adrenal insufficiency experience an adrenal crisis at some point each year. The mortality rate linked to adrenal crises is up to 6%.