Acute adrenal crisis Health Article

Definition

Acute adrenal crisis is a life-threatening condition that occurs when there is not enough cortisol, a hormone produced by the adrenal glands.

Alternative Names

Adrenal crisis; Addisonian crisis; Acute adrenal insufficiency

Causes, incidence, and risk factors

The two adrenal glands are located on top of the kidneys. They consist of the outer portion, called the cortex, and the inner portion, called the medulla. The cortex produces three types of hormones, all of which are called corticosteroids.

Cortisol is a glucocorticoid -- a corticosteroid that:

• Helps regulate blood sugar (glucose)
• Holds back the immune response
• Is released as part of the body's response to stress

Cortisol production is regulated by a small gland just below the brain called the pituitary gland. Cortisol is essential for life.

Adrenal crisis occurs when:

• The adrenal gland is damaged (Addison's disease, primary adrenal insufficiency)
• The pituitary gland is injured (secondary adrenal insufficiency)
• Adrenal insufficiency is not properly treated

Risk factors for adrenal crisis include:

• Dehydration
• Infection and other physical stress
• Injury to the adrenal or pituitary gland
• Stopping treatment with steroids such as prednisone or hydrocortisone too early
• Surgery
• Trauma

Symptoms

• Abdominal pain
• Confusion or coma
• Darkening of the skin
• Dehydration
• Dizziness or light-headedness
• Fatigue
• Flank pain
• Headache
• High fever
• Joint pain
• Loss of appetite
• Loss of consciousness
• Low blood pressure
• Nausea
• Profound weakness
• Rapid heart rate
• Rapid respiratory rate (see tachypnea)
• Shaking chills
• Skin rash or lesions
• Slow, sluggish movement
• Unintentional weight loss
• Unusual and excessive sweating on face or palms
• Vomiting

Signs and tests

• ACTH (cortrosyn) stimulation test
• Cortisol level
• Fasting blood sugar
• Serum potassium
• Serum sodium