Adrenal crisis

Referred to as an adrenal crisis, also called acute adrenal insufficiency.

A life-threatening medical emergency.

It is increasing in frequency, despite the presence of effective preventive management.

An adrenal crisis is defined, in an adult as a acute deterioration in health status associated with hypotension or relative hypotension, resolves within 1-2 hours after parenteral glucocorticoid administration.

In infants and young children adrenal crisis is defined as an acute deterioration in health status associated with an acute hemodynamic disturbance with hypotension or sinus tachycardia relative to age or marked electrolyte abnormality of hyponatremia, hyperkalemia, or hypoglycemia not attributable to another illness: After parenteral glucocorticoid administration, the crisis resolves substantially.

Patients of all ages experience symptoms to include: acute abdominal symptoms, delirium, obtundation, hyponatremia, hyperkalemia, hypoglycemia, and fever.

While adrenal crises are the most severe manifestations of adrenal insufficiency, mild or hypo adrenal states symptomatology are shared and the symptoms include: anorexia, nausea, vomiting, fatigue, postural dizziness, abdominal pain, limb pain, back pain, and impaired consciousness.

In pituitary apoplexy, the main initial problem is a lack of secretion of adrenocorticotropic hormone (ACTH, corticotropin), which stimulates the secretion of cortisol by the adrenal gland, occurring in 70% of those with pituitary apoplexy. 

The sudden lack of cortisol in the body leads to an adrenal crisis, the main cause of adrenal dysfunction and low cortisol levels.

Adrenal crisis: hypotension, particularly on standing, hypoglycemia, and abdominal pain is  life-threatening and requires immediate medical attention.

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