Acute adrenal crisis

Acute adrenal crisis is an acute deficit in the ability of the adrenal glands to manufacture glucocorticoid and mineralocorticoid hormones.

How is it produced?

Acute adrenal crisis is a fairly serious clinical situation that requires emergency treatment. In it, the functional reserve of the adrenal cortex is almost depleted, releasing very low amounts of glucocorticoids, substances essential for life.

This crisis appears as a consequence of a sharp and sustained reduction in glucocorticoid levels due to the destruction of the adrenal cortex. It is seen in cases of massive bilateral bleeding from these glands, or in patients with poorly treated Addison's disease (very low doses of glucocorticoids) or in those with acute disease (eg, infection).

Thus, among the causes capable of producing an acute adrenal crisis are distinguished:

From Addison's disease, where stressful situations, infections, trauma, surgery, vomiting, diarrhea, etc., suppose an increase in the glucocorticoid needs by the patient and when not being administered they precipitate an adrenal crisis.

By abrupt withdrawal of treatment with corticosteroids for a long time. It is the most common cause of adrenal crisis.

Due to destruction of the adrenal glands in a short time: meningococcal sepsis (Waterhouse-Friderichsen syndrome), Pseudomonas sepsis, bilateral adrenal hemorrhage, adrenal infarction due to thrombosis or embolism.

Symptoms

The clinical presentation of acute adrenal insufficiency includes the following symptoms:

• Fever
• Tachycardia
• Dehydration
• Extremely low blood pressure
• Abdominal pain
• Loss of win
• nausea and vomiting
• Intense prostration
• Reduced level of consciousness

The picture usually takes an acute course, and rapidly progressive if it is not solved, leading to death.

Diagnosis

The diagnosis will be suspected in individuals in whom all their biological parameters deteriorate more or less abruptly and become unstable in the context of an acute process such as infection, or in individuals with a history of Addison's disease.

Measurement of cortisol levels in the blood will be diagnostic (they will be greatly decreased).

Treatment

The treatment of acute adrenal crisis must be very early, the essential objectives being:

• Replenish the volume of fluid in the blood.
• Correct alterations in blood ions (sodium, potassium, etc.).
• Administer glucocorticoids: Hydrocortisone intravenously at first until the patient is stabilized, and later it is introduced orally and adding, if necessary, another steroid such as fludrocortisone.
• Treat triggering processes.

Precautionary measures

The acute adrenal crisis arises most of the time, as a complication of Addison's disease, therefore, the best prevention measure consists in educating the patient towards a perfect knowledge of his disease, quickly going to his doctor, when there is any situation that decompensates it, such as trauma or infection.