Adrenal Crisis/Adrenal Insufficiency

Abstract

Adrenal crisis is an acute deterioration in a patient with adrenal insufficiency, which is usually manifested as hypovolemic shock. Adrenal insufficiency may be secondary to infections especially tuberculosis, metastasis of cancer, bilateral adrenal hemorrhage, or bilateral adrenalectomy (primary or Addison’s disease); pituitary tumors, pituitary surgery, pituitary radiation, or head trauma (secondary); or long-term steroid use (glucocorticoid-induced). Adrenal crisis may be the first presentation in up to 50% of patients with adrenal insufficiency.

If a patient has unexplained circulatory collapse, hypotension, vomiting, or diarrhea, the diagnosis of primary adrenal insufficiency should be considered. In patients with hyperpigmentation, hyponatremia, hyperkalemia, acidosis, and hypoglycemia, the diagnosis should be strongly suspected.