Adrenal Crisis

Question 1

How does a patient present in addisonian crisis?

Answer 1

• Shock (High HR, vasoconstriction, postural hypotension, oliguric, weak, confused, coma)
• Patient with known Addison’s or forgotten their steroids
• Hypoglycaemic
• Bilateral adrenal haemorrhage as a cause from meningococcaemia

Question 2

What precipitates an addisonian crisis?

Answer 2

• Infection
• Trauma
• Surgery
• Missed medication

Question 3

What is the management for an addisonian crisis?

Answer 3

• Bloods for cortisol and ACTH
• U+E (hyperkalaemia and hyponatraemia)
  1. Hydrocortisone 100mg IV stat
  2. IV fluid bolus to support BP
  3. Monitor blood glucose (hypoglycaemia)
  4. Continue hydrocortisone 100mg/8hr IV or IM and switch to PO after 72hr
  5. May need fludrocortisone
  6. Aggressively find and treat underlying cause