Adrenal Crisis

Excerpt

Adrenal crisis, or Addisonian crisis, is a severe, life-threatening condition characterized by acute adrenal insufficiency. This condition has a substantial mortality rate of 0.5 per 100 patient-years and remains a significant cause of death in individuals with adrenal insufficiency. Patients can experience rapid deterioration without timely intervention, potentially resulting in fatal outcomes either at home or shortly after hospital admission.

This endocrine emergency arises when the production of cortisol, the primary glucocorticoid (GC) adrenal hormone, is inadequate either due to internal or external factors. Early recognition and immediate intervention are crucial for saving a patient's life and improving survival rates.

Clinicians must distinguish between adrenal insufficiency and adrenal crisis, as the latter can be fatal if not treated promptly. Despite the well-described characteristics of this condition, its recognition can be challenging, resulting in delayed treatment initiation and increased morbidity and mortality rates.

Essential measures in preventing adrenal crises include educating patients and their families about sick day rules and ensuring the availability of intramuscular hydrocortisone at home.

The ongoing debate among experts in the field has led to a lack of consensus on the definition of adrenal crisis. Several expert reviews have tried to establish their definitions of adrenal crisis. Among the numerous descriptions available for this condition, we will adhere to the one put forth by Rushworth et al in 2019 for this activity, as mentioned below.

Adrenal crisis is defined by an acute deterioration in health status that is associated with the following conditions:

1. Absolute hypotension with a systolic blood pressure <100 mm Hg.

2. Relative hypotension with a systolic blood pressure ≥20 mm Hg lower than the patient's usual baseline.

Typically, these features should improve and resolve within 1 to 2 hours after administering parenteral GCs, marked by a significant reduction in hypotension within the first hour. Furthermore, there should be a gradual improvement in patients' clinical symptoms over the subsequent 2 hours.