[3] Adrenal Crisis

Question 1

What is an adrenal crisis?

Answer 1

An adrenal crisis is a life-threatening condition that mainly occurs with an acute deficiency of the glucocorticoid cortisol, and to a lesser extent the mineralocorticoid aldosterone

Question 2

Where does adrenal crisis occur commonly?

Answer 2

In people with long-term adrenal insufficiency

Question 3

What does an adrenal crisis require?

Answer 3

Emergency treatment

Question 4

What regulates cortisol production?

Answer 4

The pituitary

Question 5

What is the pituitary?

Answer 5

A small gland under the brain

Question 6

How does the pituitary regulate cortisol?

Answer 6

The pituitary releases ACTH. This causes the cortex of the adrenal gland to release cortisol

Question 7

What is the biggest risk factor for cortisol?

Answer 7

Long-term steroid therapy

Question 8

What kind of steroid therapy can cause adrenal crisis?

Answer 8

Oral steroid treatment carries the highest risk, however inhaled and topical steroids can on occasion cause adrenal insufficiency, and therefore cause adrenal crisis

Question 9

What can cause an adrenal crisis?

Answer 9

• Damage to the adrenal gland
• Injury to the pituitary preventing the release of ACTH
• Sudden withdrawal from long-term glucocorticoid medication
• Severe dehydration
• Infection, or other physical stress

Question 10

What can cause damage to the adrenal gland leading to adrenal crisis?

Answer 10

• Addison’s disease, or another adrenal gland disease
• During surgery

Question 11

What are the symptoms of an adrenal crisis?

Answer 11

• Abdominal or flank pain
• Confusion, loss of consciousness, or coma
• Dehydration
• Dizziness or lightheadedness
• Fatigue or severe weakness
• Headache
• High fever
• Loss of appetite
• Low blood pressure
• Nausea, vomiting
• Rapid heart rate
• Rapid respiratory rate
• Slow, sluggish movement
• Unusual and excessive sweating of face and palms

Question 12

What investigations are done in adrenal crisis?

Answer 12

• ACTH stimulation test
• Cortisol level
• Blood sugar
• Potassium level
• Sodium level
• pH level

Question 13

Should you wait for confirmation of adrenal function before treating a suspected adrenal crisis?

Answer 13

No - treatment should be started immediately on clinical features

Question 14

How is an adrenal crisis managed?

Answer 14

• IV or IM hydrocortisone
• IV fluids if low BP
• Continuous cardiac and electrolyte monitoring
• Treat underlying cause

Question 15

What dose of hydrocortisone is given in adrenal crisis in adults?

Answer 15

100mg

Question 16

What should be done following initial management and rehydration in adrenal crisis?

Answer 16

Administration of 100-200mg hydrocortisone in 5% glucose over 24 hours infusion

Question 17

What should be done once a patient with adrenal crisis is stabilised after initial management?

Answer 17

Gradual reduction of IV steroid dose and re-institution of oral therapy

Question 18

What can cause death in adrenal crisis?

Answer 18

Circulatory collapse and arrhythmias, with hypoglycaemias contributing