61 - Adrenal crisis

Summary

This chapter discusses the diagnosis, evaluation and management of adrenal crisis. It presents special circumstances with regard to steroids and sepsis, chronic adrenal insufficiency and sepsis, and chronic adrenal insufficiency and procedures. Patients with adrenal insufficiency usually present with nonspecific symptoms including weakness/fatigue, weight loss, anorexia, abdominal pain, fever, and depression. Acute adrenal insufficiency can appear to be a severe gastroenteritis with fever, vomiting, and dehydration, but this can quickly progress to vascular collapse and death. Refractory hypotension is the hallmark of adrenal crisis. If the patient with suspected adrenal insufficiency experiences sudden cardiovascular collapse, adrenal hemorrhage must be considered. Hydrocortisone 100 mg IV should be started, and central venous access is obtained to give fluids and vasopressors for resuscitation. If the BP does not improve, fludrocortisone can be added. If the patient continues to deteriorate, another cause should be suspected.