Adrenal crisis

Question 1

Cause

Answer 1

• Abrupt cessation of long-term oral steroids after 3 weeks (steroids mimic cortisol & suppress CRH release from hypothalamus & ACTH release from anterior pituitary therefore zona fasciculata atrophies & endogenous cortisol production decreases)
• Adrenal insufficiency & intercurrent illness/infection/surgery (double dose of hydrocortisone as cortisol is needed for stress response)

Question 2

Presentation

Answer 2

Adrenal insufficiency (bronze skin pigmentation in palmar creases = key sign of PAI) &
- reduced consciousness
- nausea & vomiting
- abdominal pain
- severe dehydration (no aldosterone therefore decreased water reabsorption) & hypotension -> pre-renal AKI
- hypoglycaemia

Question 3

Treatment

Answer 3

1st line = IV hydrocortisone 100mg
then IV saline + dextrose if hypoglycaemia (cortisol normally increases blood glucose)
then 200mg hydrocortisone over next 24 hrs