User:Mr. Ibrahem/Adrenal crisis

Adrenal crisis
Other names	Addisonian crisis, acute adrenal insufficiency
Forty-nine year-old with an adrenal crisis. Appearance shows lack of facial hair, dehydration, loss of the outer eyebrow (panel A), pale skin, muscular and weight loss, and loss of body hair (panel B).
Specialty	Emergency medicine, endocrinology
Symptoms	Confusion, abdominal pain, nausea, vomiting, fever, low blood pressure
Complications	Seizures, irregular heart rate, organ failure
Usual onset	Sudden
Causes	Triggering event in adrenal insufficiency
Diagnostic method	Supported by: High blood potassium, low blood sodium, low cortisol level Confirmed by: ACTH stimulation test
Differential diagnosis	Shock, heart attack, myxedema coma, gastroenteritis
Prevention	Doubling usual dose of steroids when unwell
Treatment	Hydrocortisone, intravenous fluids, vasopressors, dextrose, antibiotics
Prognosis	Risk of death up to 25%
Frequency	3 in 100,000 per year

Adrenal crisis is a complication of adrenal insufficiency that may occur following a triggering event. Symptoms are of sudden onset and may include confusion, abdominal pain, nausea, vomiting, fever, and low blood pressure. Complications may include seizures, irregular heart rate, and organ failure.

Adrenal insufficiency may occur due to Addison's disease, Waterhouse–Friderichsen syndrome, chronic glucocorticoid use, or pituitary apoplexy. However, in more than half of crisis people do not realize that they have adrenal insufficiency. Triggers may include stopping corticosteroids after prolonged use, infection, injury, thyrotoxicosis, strenuous exercise, alcohol, and emotional stress. The underlying mechanism involves not enough of the hormone cortisol. Diagnosis is supported by a high blood potassium, low blood sodium, and low cortisol level. Confirmation is by an ACTH stimulation test.

Prevention is by doubling a person's usual dose of steroids when unwell. Treatment is generally by giving an injection of hydrocortisone, though methylprednisolone or dexamethasone may also be used. Intravenous fluids, vasopressors, dextrose, and antibiotics may also be needed.

Primary adrenal insufficiency affects about 5 per 100,000 people while secondary adrenal insufficiency affects about 22 per 100,000 people. In those with adrenal insufficiency adrenal crisis occurs in about 5% to 10% a year. Older people are more commonly affected. In those with adrenal insufficiency 1 in 200 die per year from this complication. During an adrenal crisis the risk of death is as high as 25%.