Adrenal Crisis

Adrenal crisis is a bit like DKA. It can either be caused by chronic adrenal insufficiency plus a trigger, or it can be caused by acute adrenal insufficiency alone - Josh Farkas

Adrenal Crisis
Adrenal Crisis

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Adrenal Crisis

Basically people in adrenal crisis can present with any chief complaint. They may have pains, infections, weakness, confusion, skin changes. The big kicker to this, is that they will look sick. Their pressures will be low and will stay low in spite of your iv fluid resuscitation. Normally cortisol has an additive effect with catecholamines to vasoconstrict… now, however without enough cortisol vasodilation will reign...

If this patient says- hey, I’ve got the Addison’s disease, or their chart says “hx of Adrenal crisis” and so you know that this is likely an Adrenal Crisis. Then you given them Hydrocortisone bolus (100mg IV) and get them up to the ICU.

If this is looking…

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 Adrenal Crisis

If this patient says- hey, I’ve got the Addison’s disease, or their chart says “hx of Adrenal crisis” and so you know that this is likely an Adrenal Crisis. Then you given them Hydrocortisone bolus (100mg IV) and get them up to the ICU.

Life in the Fastlane

concurrent illness, surgery, failure to take medications...

WikEM

Hypotension (refractory to fluids/pressors)(90%).

StatPearls

Acute adrenal crisis can be the first presentation of unknown adrenal insufficiency and can occur in up to 50% of patients with known adrenal insufficiency.

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