Addisonian crisis Flashcards
What are 4 types of causes of Addisonian crisis?
- Stress e.g. sepsis or surgery causing an acute exacerbation of chronic insufficiency (Addison’s, hypopituitarism)
- Adrenal haemorrhage e.g. Waterhouse-Friderichsen syndrome (fulminant meningococcaemia)
- Steroid withdrawal
- Pituitary apoplexy
What is the definition of Addisonian crisis?
serious medical condition caused by body’s inability to produce a sufficient amount of cortisol
What are 5 examples of stress which may precipitate Addisonian crisis in patients with a background of chronic insufficiency?
- Gastrointestinal illness (most common)
- Other infections including sepsis
- Perioperative period
- Physical stress or pain
- Psychological stress
What is the commonest cause of stress leading to Addisonian crisis on a background of chronic insufficiency?
Gastrointestinal illness
What are 7 signs and symptoms of Addisonian crisis?
- Hypotension, shock
- Imapired consciousness
- Coma
- Fever
- Vomiting
- Diarrhoea
- Severe abdominal pain (which can resemble peritoniitis)
What are 3 areas of investigations in suspected Addisonian crisis?
- Based on clinical suspicion: low threshold in at-risk patients e.g. shock refractory to fluids and/or vasopressors
- Routine bloods
- Endocrine testing
What are 3 types of routine tests which can help confirm a diagnosis of Addisonian crisis?
- U+Es: hyponatraemia, hyperkalaemia, hypocalcaemia
- Glucose: Hypoglycaemia
- Blood gas: Normal anion gap metabolic acidosis
What are the cardinal 3 electrolyte abnormalities in Addisonian crisis?
- Hyponatraemia
- Hypoglycaemia
- Hyperkalaemia
What are 2 forms of endocrine testing to perform if the diagnosis of Addisonian crisis is uncertain?
- Random cortisol level (prior to hydrocortisone administration)
- ACTH stimulation test: once patient stable
When are more specific endocrine tests peformed to confirm a diagnosis of Addisonian crisis?
if diagnosis is uncertain
What are the 4 aspects of management of Addisonian crisis?
- 1L fluid resuscitation if hypotensive
- IV hydrocortisone 100mg (or IM)
- IV glucose if hypoglycaemic
- Swab back to their oral steroids after 3 days
What are the 2 routes that hydrocortisone can be given in Addisonian crisis and what is the dose?
IM or IV, 100mg
Which fluids should be given in a patient with Addisonian criis?
1L 0.9% NaCl over 30-60 min or with dextrose if hypoglycaemic
How frequently is hydrocortisone given after the initial dose in Addisonian crisis?
continue 6 hourly until patient is stable
Why is no fludrocortisone initially needed for the management of Addisonian crisis?
high cortisol exerts weak mineralocorticoid action
