Acute adrenocortical insufficiency is an emergency caused by insufficient cortisol.
Adrenal crisis may occur in the following situations:
(A) during stress,(eg, trauma, surgery, infection, hyperthyroidism, or prolonged fasting) in a patient with latent or treated adrenal insufficiency;
(B) following sudden withdrawal of adrenocortical hormone in a patient with chronic insufficiency or in a patient with temporary insufficiency due to suppression by exogenous corticosteroids or megestrol
(C) following sudden destruction of the pituitary gland (pituitary necrosis), or when thyroid hormone is given to a patient with hypoadrenalism.
(D) following injury to both adrenals by trauma, hemorrhage, anticoagulant therapy, thrombosis, infection or, rarely, metastatic carcinoma.
(E) following administration of etomidate, which is used intravenously for rapid anesthesia induction or intubation.
SYMPTOMS
In Acute adrenocortical insufficiency patient complains of headache, lassitude, nausea and vomiting, abdominal pain, and often diarrhea. Confusion or coma may be present. Weakness, abdominal pain, fever, confusion, nausea, vomiting, and diarrhea. Low blood pressure, dehydration; skin pigmentation may be increased. Serum potassium high, sodium low, BUN high.
If the diagnosis is suspected, draw a blood sample for cortisol determination and treat with hydrocortisone. 100-300 mg intravenously, and saline immediately, without waiting for the results. Thereafter give hydrocortisone phosphate or hydrocortisone sodium succinate, 100 mg intravenously immediately and continue intravenous infusions of 50-100 mg every 6 hours for the first day. Give the same amount every 8 hours on the second day and then adjust dosage in view of the clinical picture.
TREATMENT
Since bacterial infection frequently precipitates acute adrenal crisis, broad-spectrum antibiotics should be administered empirically while waiting for the results of initial cultures. The patient must be treated for electrolyte abnormalities, hypoglycemia and dehydration.
Oral hydrocortisone, 10-20 mg four times a day and reduce dosage to maintenance levels as required. Mineralocorticoid therapy is not needed when large amounts of hydrocortisone are being given, but as the dose is reduced it is usually necessary to add fludrocortisone acetate, in the therapy. Once the crisis has passed, the patient must be evaluated to assess the degree of permanent adrenal insufficiency and to establish the cause if possible.
Rapid treatment will usually be lifesaving. However, acute adrenal insufficiency is frequently unrecognized and untreated since its manifestations mimic more common conditions.
For Informational purpose only. Consult your Physician for advice.