Acute Adrenal Crisis

Question 1

What is an acute adrenal crisis?

Answer 1

A life-threatening state of adrenocorticosteroid hormone deficiency leading to hypotension and hemodynamic shock.

Question 2

What are the clinical features of an acute adrenal crisis?

Answer 2

1. HoTN/shock/orthostasis
2. Anorexia, N/V
3. Abdominal pain
4. Fever
5. Lethargy/weakness

Question 3

What is also on the differential diagnosis for someone suspected to have acute adrenal crisis?

Answer 3

1. Shock
2. Anaphylaxis
3. Other causes of HoTN

Question 4

What is the management of acute adrenal crisis?

Answer 4

1. Ensure adequate airway and gas exchange
2. Administer high-flow oxygen/100% FiO2
3. Expand the circulating volume rapidly with D5NS (up to 2 - 3 L)
4. Draw blood for random cortisol and ACTH
5. After blood draw, administer IV glucocorticoid: hydrocortisone 100mg (and continue q6hr as needed)
6. Vasopressors
7. Correct electrolyte disturbances
8. Identifying preciptating cause
9. Rule out other causes on the differential diagnosis