Adrenal Crisis

Question 1

Essentials of diagnosis for what issue?
(a) Weakness, abdominal pain, fever, confusion, vomiting
(b) Low blood pressure, dehydration
(c) Skin pigmentation may be increased
(d) Insufficient aldosterone will result in elevated serum potassium and low sodium.
(e) Insufficient cortisol may result in hypoglycemia
(f) Dehydration and hypotension may result in poor kidney perfusion (may see elevated blood urea nitrogen and creatinine)

Answer 1

Acute Adrenal Crisis- Adrenocortical Insufficiency

Question 2

An emergency caused by insufficient mineralocorticoid (aldosterone) and glucocorticoid (cortisol)

Answer 2

Acute Adrenal Crisis

Question 3

Primary and Secondary
a) _______ - resulting from destruction or dysfunction of the adrenal cortex.
b) _______ - resulting from ACTH hyposecretion.

Answer 3

a) primary
b) Secondary

Question 4

Adrenocortical Insufficiency
May occur during stress (e.g., trauma, surgery, infection, hyperthyroidism, or prolonged fasting) in a patient with latent insufficiency or treated adrenal insufficiency with sudden withdrawal of ________

Answer 4

adrenocortical hormones
(e.g.
prednisone or fludrocortisone)

Question 5

If steroids are stopped or decreased too quickly, what can happen?

Answer 5

the adrenal glands may not begin making cortisol again fast enough to meet the body’s needs.

Question 6

True/FAlse
Higher doses and longer treatments decrease the risk of adrenal
insufficiency.

Answer 6

False

Question 7

What issue?
*Symptoms:
1) Headaches
2) Lassitude (lethargy)
3) Nausea/Vomiting
4) Abdominal pain and diarrhea
5) Confusion or coma
6) Cyanosis
7) Dehydration
8) Sparse Axillary hair
*Signs:
1) Skin hyperpigmentation
2) Fever
3) Hyperkalemia
4) Hyponatremia
5) Hypotension
6) Eosinophilia

Answer 7

Acute Adrenal Crisis -Adrenal insufficiency

Question 8

True/FAlse
Though eosinophils are generally associated with parasitic infections or allergy, peripheral eosinophilia is also commonly seen in adrenal insufficiency.

Answer 8

True

Question 9

Treatment Acute Adrenal insufficiency

Answer 9

1) immediately treat with hydrocortisone 100-300 mg IV and saline.
2) Then continue hydrocortisone 50-100mg IV Q6H for first day, Q8H the second day, and taper as clinically appropriate.

Question 10

True/False
Acute adrenal insufficiency is a medical emergency, and treatment should be delayed pending laboratory results

Answer 10

FALSE
do not delay treatment

Question 11

Disposition acute adrenal insufficiency

Answer 11

MEDEVAC as soon as possible

Question 12

Patients treated for acute adrenal insufficiency and diagnosed with Addison’s disease require …..

Answer 12

lifelong replacement therapy with both glucocorticoids and mineralocorticoids

Question 13

acute adrenal insufficiency Complications

Answer 13

(a) Shock and death if untreated
(b) Sequelae of infection that commonly precipitate adrenal crisis

Question 14

Essentials of diagnosis for what issue?
(a) Weakness, fatigability, anorexia, weight loss; nausea/vomiting, diarrhea; abdominal pain, muscle and joint pains; amenorrhea.
(b) Sparse axillary hair; increased skin pigmentation, especially of creases, pressure areas, and nipples.
(c) Hypotension, small heart.
(d) Potassium high, sodium low, blood urea nitrogen high
(e) Plasma cortisol levels are low or fail to rise after administration of corticotropic. Elevated ACTH level.

Answer 14

Chronic Adrenal Insufficiency

Question 15

_________ is an uncommon disorder caused by destruction or dysfunction of the adrenal cortices.

Answer 15

Addison disease

Question 16

Characterized by chronic deficiency of (what hormones?) and causes skin pigmentation that can be subtle or strikingly dark.

Answer 16

cortisol, aldosterone, and adrenal androgens

Question 17

Chronic Adrenal Insufficiency
If _______ is not elevated, skin pigmentary changes are not encountered

Answer 17

ACTH

Question 18

________ is a leading cause of Addison disease (rare in US), decreased since the 1960s.

Answer 18

Tuberculosis

Question 19

What issue?
*Symptoms:
1) Weakness and fatigability
2) Weight loss
3) Myalgias
4) Arthralgia’s
5) Anorexia
6) Nausea/Vomiting
7) Anxiety
8) Mental irritability
*Signs:
1) Hyperpigmentation skin changes
2) Hypopigmented skin (Vitiligo 10%)
3) Hypoglycemia
4) Hypotensive blood pressure
5) Nail beds (longitudinal pigmented bands)
6) Small heart
7) Scant axillary and pubic hair

Answer 19

Chronic Adrenal Insufficiency

Question 20

Lab/imaging findings
(a) CBC with differential:
(b) Serum Electrolytes:
(c) Serum Glucose:
(d) Cortisol:

Answer 20

(a) CBC with differential:
–1) Moderate neutropenia
–2) Lymphocytosis
–3) Eosinophilia (Eos > 300/mcL)
(b) Serum Electrolytes:
–1) Low Na+
–2) Elevated K+
(c) Serum Glucose:
–1) Low
(d) Cortisol:
–1) Low (< 3 mcg/dL) at 8 am is diagnostic
–2) ACTH elevation (usually > 200 pg/mL)

Question 21

Treatment Chronic Adrenal Insufficiency

Answer 21

Hydrocortisone is the drug of choice. Most Addison patients are well
maintained on 15 – 30 mg of hydrocortisone orally daily in two divided doses.

Question 22

Disposition Chronic Adrenal Insufficiency

Answer 22

MEDEVAC

Answer 23

Acute Adrenal Crisis- Adrenocortical Insufficiency