ADRENAL CRISIS

(Acute adrenal insufficiency)

This is a medical emergency caused by suddenly marked insufficiency of adrenocortical hormones.

Precipitating factors

Stress: e.g. infection, trauma, surgery, prolonged fasting.

Sudden withdrawal of adrenocortical hormone therapy in a patient with chronic insufficiency.

Clinical features

Dehydration

Headache

Confusion

Coma may be present.

Fever may be 105 °F or more.

Nausea, vomiting, diarrhea & abdominal pain

Sudden onset with fall of blood pressure (cold extremities, weak pulse, tachycardia)

Investigations

• Blood glucose – low

• Serum electrolytes – low sodium, high potassium

• Blood urea – high

• Blood culture: may be positive

• Urinary & blood cortisol levels – low.

Management

Inj. normal saline (and 5% dextrose if hypoglycemia)

IV hydrocortisone  & then shift the patient to oral prednisolone.

Antibiotics

Management of shock