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Adrenal Crisis

Adrenal Crisis. Nicole Wilde UNC Morning Report 5/18/10. Adrenal Crisis: Acute Adrenal Insufficiency . Primary Adrenal Insufficiency Serious infection Acute stress in previously undiagnosed cases No extra glucocorticoid therapy during infection Abrupt withdrawal from glucocorticoids

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Adrenal Crisis

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  1. Adrenal Crisis Nicole Wilde UNC Morning Report 5/18/10

  2. Adrenal Crisis: Acute Adrenal Insufficiency • Primary Adrenal Insufficiency • Serious infection • Acute stress in previously undiagnosed cases • No extra glucocorticoid therapy during infection • Abrupt withdrawal from glucocorticoids • Bilateral adrenal infarction • Bilateral adrenal Hemorrhage

  3. Signs/Symptoms • Shock • Anorexia • Nausea/Vomiting • Abdominal Pain • Weakness/Fatigue • Fever • Confusion/Coma

  4. Bilateral Adrenal Hemorrhage or Infarction • Before CT was diagnosed on autopsy • Look for hyperkalemia, hyponatremia, and occult hemorrhage • Risk Factors • Anticoagulant therapy • Coagulopathy • Post operative State • Meningococcemia or Pseudmonas (sepsis)

  5. Pituitary Apoplexy • Adrenal crisis is rare with pituitary or hypothalamic adrenal insufficiency • Hypovolemia rare due to normal Renin-agiotensin-aldosterone system • Crisis can occur with Pituitary infarct • Acute cortisol deficiency

  6. Chronic 1° Adrenal Insufficiency • Glucocorticoid, mineralocorticoid, and androgen deficiency (women) • Dehydration • Hyperpigmentation • Hyperkalemia • Secondary and Tertiary adrenal insufficiency have normal mineralocorticoid function

  7. Diagnosis • Random Cortisol • Acute ACTH Stimulation Test • Determine cause: CT abdomen, MRI Head, Rule out sepsis, look for autoimmune disease, etc.

  8. Treatment • Treat Hypotension • Reversal of Electrolyte Abnormalities • IVF • Dexamethasone if measuring cortisol • Hydrocortisone for no biochemical tests • Fludocortisone

  9. The End

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