Adrenal Crisis



Adrenal Crisis


William Mounstephen



Introduction



  • Often presents with nonspecific complaints


  • Requires high index of suspicion


  • Adrenal cortex unable to produce enough glucocorticoid and mineralocorticoid in response to stress








Table 44.1 Adrenal Insufficiency









Primary

Glucocorticoid and mineralocorticoid production affected




  • Congenital (CAH)



  • Autoimmune



  • Adrenal hemorrhage



  • Infection: TB, histoplasmosis, meningococcemia


Secondary

Only glucocorticoid production affected




  • Suppression of ACTH in patients on pharmacologic dosages of glucocorticoids



Clinical Presentation


Primary Adrenal Insufficiency



  • Gradual onset of symptoms/complaints such as weakness, fatigue, malaise, anorexia, weight loss


  • Salt craving


  • Hypotension


  • Skin hyperpigmentation: lips, buccal mucosa, nipples, groin, palmar/axillary creases, areas of old scars or friction


Infancy



  • Most common cause is congenital adrenal hyperplasia (CAH): failure to thrive, vomiting,
    dehydration, hyperpigmentation of genitalia, ambiguous genitalia


  • Rare before 5-7 days of life


Older Child/Adolescent

Tags:
Jun 22, 2016 | Posted by in EMERGENCY MEDICINE | Comments Off on Adrenal Crisis

Full access? Get Clinical Tree
Get Clinical Tree app for offline access