Page 229 - Critical Care Notes

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Adrenal Crisis
Acute adrenal crisis, also known as acute adrenal insufficiency, is a serious
complication of a dysfunctional adrenal gland causing difficulties in producing
aldosterone and cortisol hormones.
Pathophysiology
Destruction of adrenal cortex → hindered secretion of aldosterone and cortisol →
Addison’s disease → hypoglycemia and hypovolemic shock → coma and death.
Risk factors for adrenal crisis include:
■ Recently discontinued long-term corticosteroid therapy
■ Injury to or infection of the adrenal gland
■ Chronic adrenal insufficiency
■ Bilateral adrenalectomy
■ Medications that suppress adrenal hormones
■ Medications that enhance steroid metabolism
■ Sepsis
Clinical Presentation

■ Serious muscle weakness, fatigue
■ Hyperpigmentation
■ Hypoglycemia
■ Fever
■ Headache
■ Nausea, vomiting, poor appetite or anorexia
■ Dehydration and electrolyte imbalances
■ Abdominal or flank pain
■ Diarrhea
■ Altered mental status, lethargy, or confusion
■ Hypotension, circulatory shock
■ Tachycardia, dysrhythmias
■ Lack of response to vasopressors
Diagnostic Tests
■ Cosyntropin (ACTH) stimulation test
■ Plasma cortisol
■ Metyrapone (Metopirone) test for diagnosis

ENDO