Adrenal Crisis

(Acute Adrenocortical Insufficiency)
Definition
Adrenal crisis is a life-threatening condition in which the anterior pituitary gland does not make enough adrenocorticotropic hormone (ACTH). ACTH is responsible for regulating the adrenal gland (a gland near the kidneys that makes hormones that regulate bodily functions).
Adrenal crisis is very serious, and people with adrenal crisis require immediate treatment. If you suspect you have this condition, seek emergency medical care immediately.

Causes
Adrenal crisis may be caused by:
• Rapid withdrawal from steroid therapy
• Sepsis (bloodstream infection)
• Surgical stress
• Adrenal apoplexy (ie, bleeding into the adrenal glands)
• Pituitary necrosis
• Thyroid hormone replacement in someone with adrenal insufficiency
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition. The following factors increase your chances of developing adrenal crisis. If you have any of these risk factors, tell your doctor:
• Septic shock
• Adrenal insufficiency
• Use of steroid medications
Symptoms
If you experience any of these symptoms do not assume it is due to adrenal crisis. These symptoms may be caused by other, less serious health conditions. If you experience any one of them, see your physician.
• Weakness
• Feeling tired all the time
• Nausea
• Vomiting
• Loss of appetite
• Weight loss
• Low blood pressure
• Abdominal pain
• Fever
• Confusion or coma
• Diarrhea
• Bluish skin color
• Dehydration
Diagnosis
Your doctor will ask about your symptoms and medical history, and perform a physical exam. Tests may include the following:
• Blood tests to measure hormone levels, look at red blood cells, electrolytes levels, and test for autoimmune or endocrine disorders
• Chest x-ray
• Computed tomography (CT) scan of the abdomen –a type of x-ray that uses a computer to make pictures of structures inside the body
Treatment
Talk with your doctor about the best treatment plan for you. Treatment options include the following:
Medications
Steroid and antibiotics drugs are needed in an adrenal crisis. If you are vomiting or unconscious, these medications will be given by injection or through an IV (intravenous).
Prevention
To help reduce your chances of having adrenal crisis, take the following steps:
• If you are always tired, feel weak, or have had unexplained weight loss, then see your doctor to find out if you have a shortage of adrenal hormones.
• If you take hydrocortisone, prednisone, or dexamethasone, learn how to increase your dose if you become ill.
• If you have adrenal gland problems and become ill (eg, nausea, vomiting), seek emergency medical care immediately.
• If you have adrenal gland problems, make sure you have a hydrocortisone injection with you at all times, and ensure that you and those around you know how to give the injection.
• If you have adrenal insufficiency, carry a medical ID card and wear a bracelet that tells emergency workers about your problem.