Adrenal crisis

• Adrenal crisis, also known as Addisonian crisis, describes an acute presentation of severe adrenal insufficiency, where the absence of steroid hormones leads to a life-threatening emergency.
• Patients may present with:

  • Reduced consciousness
  • Hypotension
  • Hypoglycaemia
  • Hyponatraemia
  • Hyperkalaemia
• It may be the initial presentation of adrenal insufficiency or triggered by infection, trauma or other acute illness in established adrenal insufficiency. Do not wait to perform investigations and establish a definitive diagnosis before starting treatment in suspected adrenal crisis. 
• Management involves:

  • ABCDE approach to initial assessment and arrange transfer to hospital
  • Intramuscular or intravenous hydrocortisone (the initial dose is 100mg, followed by a 200mg/24hr infusion)
  • Intravenous fluids
  • Correct hypoglycaemia (e.g. IV dextrose)
  • Careful monitoring of electrolytes and fluid balance