Definition

An adrenal crisis is a medical emergency with life-threatening potential. It occurs when the adrenal glands fail to produce enough cortisol hormone to meet the body's demands. This condition is also known as Addisonian Crisis or acute adrenal insufficiency.

Adrenal glands are small glands shaped like triangles above the kidneys. This gland produces a hormone called cortisol. Cortisol impacts almost all organs in the body, which are included in the cortisol function, among others:

• Regulates the body's response to stress
• Help control the body's metabolism
• Lowering the process of inflammation or inflammation in the body
• Regulate blood sugar levels in the body
• Help control sleep cycles and build-ups in the body

Patients experiencing an adrenal crisis can feel dizzy heads, fatigue, stomach pain, vomiting nausea, and even loss of consciousness. This crisis can occur at any age but most often occurs at the age of between 30 and 50 years.

The number of adrenal crises is rare. A study estimates that an adrenal crisis occurred in around 42% of patients suffering from adrenal insufficiency, and 25% of them died.

Causes

Persistently low cortisol levels are the cause of an adrenal crisis. Inadequate levels of the cortisol hormone may result from prolonged infections or a history of trauma, both of which may inhibit the production of cortisol signals.

Risk Factor

The following are risk factors for adrenal crisis:

• The historical usage of steroids, including topical steroids and inhalation steroids
• Past infection involving Haemophilus influenza, Staphylococcus aureus, and Streptococcus pneumoniae
• Meningococcemia history
• History of chronic stress
• Tuberculosis's historical background
• HIV/AIDS History
• Dehydration

Read more: Pulmonary Tuberculosis (TB) - Definition, Causes, Symptoms, and Treatment

Symptoms

Symptoms of an adrenal crisis include:

• Headache
• Fatigue
• Slow movement
• Nauseous
• Vomiting
• Hypotension
• Dehydration
• High fever
• Shivering
• Disorientation or unconsciousness
• Hyperpigmentation
• Tachycardia
• Abdominal pain
• Arthralgia
• Weight loss
• Loss of appetite

Inability to receive appropriate treatment for adrenal insufficiency, damage to the adrenal glands, dehydration, hypopituitary, infection, emotional tension, or discontinuation of corticosteroid medications after regular use are all potential causes and factors for these symptoms.

Diagnosis

The diagnosis of an adrenal crisis is determined through the process of anamnesis, or medical interview, physical examinations, and other additional examinations.

Anamnesis

The history-taking process is carried out through an interview between the doctor and the patient. Questions to diagnose adrenal crisis include the patient's chief complaint, accompanying symptoms, past medical history, family history, medication use, and daily activity history. Anamnesis is performed only when possible. In some emergency situations, anamnesis is not necessary, and prioritizing examination and management is prioritized.

Physical Examination

During a physical examination, a patient's vital signs, such as blood pressure, temperature, respiration rate, and pulse, are closely monitored. Following this, the doctor conducts a thorough assessment of the entire body to evaluate the condition of internal organs and overall health.

Additional Examination

Laboratory examinations for evaluating glucose, cortisol, pH, potassium, and sodium levels in the blood are some of the additional examinations that are administered. At the same time, other tests can be ordered to rule out other possible causes of the patient's adrenal crisis.

Management

During the management of an adrenal crisis, a doctor may administer an intravenous injection of hydrocortisone dissolved in a saline solution. This injection serves as a viable replacement for inadequate levels of cortisol in instances of patients experiencing adrenal crisis. Nevertheless, hydrocortisone injection may lead to various side effects such as allergic reactions, melena (black feces), fever, sore throat, cough, mood alterations, and discomfort in the ribs, shoulders, hands, and feet.

If an adrenal crisis coincides with a bacterial illness, the doctor may give antibiotics. Doctors can also prescribe medications based on the symptoms. These drugs are administered to help relieve symptoms.

Water or coconut water is indicated for dehydrated patients to maintain electrolyte levels. Carbohydrate-rich diets are indicated for hypoglycemic patients.

If you want to know more about melena, you can read it here: Melena - Definition, Causes, Symptoms, and Treatment

Complications

Several significant problems can result from an adrenal crisis, including:

• Seizures
• Heart rhythm disorders (arrhythmia)
• Deterioration of consciousness, ranging from disorientation to coma
• Electrolyte imbalances, including hyponatremia and hypokalemia
• Imbalances in blood sugar levels, such as hypoglycemia, can result in organ dysfunction or "shock" if not immediately treated

Read more about shock here: Shock - Definition, Causes, Symptoms, and Treatment

Prevention

Adrenal crises frequently manifest in people with concurrent adrenal insufficiencies. It is possible to ascertain the specific causes that precipitate an adrenal crisis. By following that approach, one can prevent the occurrence of an adrenal crisis. Precipitating factors for an adrenal crisis encompass emotional stress, dehydration, infection, and the administration of regularly prescribed glucocorticoid medications.

Surgery and pregnancy can potentially cause adrenal insufficiency and crisis. You can notify your doctor about adrenal insufficiency, especially if you're pregnant or having surgery.

To avoid an adrenal crisis, check your blood pressure and weight often and notify your doctor.

Your doctor might also advise you to receive cortisol injections in an emergency. They will instruct you on the proper administration schedule and method of this injection. It is imperative to exercise caution when storing this medication due to the potential necessity of a cortisol injection in an emergency. Additionally, you can instruct family members or close acquaintances on how to administer cortisol injections so they can assist you in administering first aid during emergencies or when you are unable to do so yourself.

When to See a Doctor?

Immediately consult a physician if you develop symptoms and signs consistent with an adrenal crisis. Visiting an internal medicine specialist is advisable for individuals who are afflicted with symptoms, including physical or psychological tension. You may inquire with your physician about how to treat your condition, the potential adverse effects, the proper storage of your medications, and the triggers for an adrenal crisis.

If you are aware of the specific triggers for an adrenal crisis, proceed to the emergency room without delay.

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