Adrenal crisis

• Adrenal crisis occurs when a person with Addison's disease experiences severe physical stress. The adrenal glands cannot supply the extra cortisol needed to cope with the stress, and life-threatening symptoms develop
• Adrenal crisis may result in severe dehydration, hypotension, hypovolaemic shock, altered consciousness, seizures, stroke, or cardiac arrest.
• • Children with adrenal crisis are more susceptible to hypoglycaemia that if not promptly recognized and treated can result in death or permanent brain damage.
• The most common causes of adrenal crisis in people with diagnosed Addison’s disease are:

  • Gastrointestinal illness (23%).
  • Other infections (25%).
  • Peri-operatively (10%).
  • Physiological stress/pain (9%).
• Adrenal crisis requires emergency admission to hospital and give IM/IV 100mg hydrocortisone (adults) and stabilise with IV saline infusion.
• Types of hydrocortisone which are licensed for use in adrenal crisis:

  • Hydrocortisone sodium phosphate (Efcortesol) - risk of pain and parasthesia
  • Hydrocortisone sodium succinate (Sola-cortef) - powder form
  • DO NOT GIVE Hydrocortisone acetate injection
• In adrenal crisis emergency fludrocortisone is not required because high dose hydrocortisone has a mineralocorticoid effect.