An Overview of Adrenal Crisis

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An adrenal crisis occurs when there is not enough cortisol in the body. It is a life-threatening situation that requires immediate medical attention.

The adrenal glands are located right on top of the kidneys and are responsible for the production of a hormone called cortisol. Cortisol helps to control blood pressure levels and blood sugar levels and is released as part of the body’s stress response.

Symptoms

Some of the symptoms of adrenal crisis are

  • Hypotension (Low blood pressure)
  • Hypovolemic shock
  • Nausea
  • Vomiting
  • Hypoglycemia
  • Abdominal/stomach pain
  • Weakness
  • Confusion
  • Weakness
  • Coma
  • Light-headedness

Causes

Adrenal crisis can be caused by a myriad of reasons.

Primary Adrenal Insufficiency

Also known as Addison’s disease, this is a condition where there is an insufficiency of cortisol in the body caused by problems with the adrenal glands themselves. There are many conditions which can cause primary adrenal insufficiency and some of them are:

  • Autoimmune Adrenalitis: the most common cause of primary adrenal insufficiency. In it, the immune system attacks and gradually destroys the adrenal glands.
  • Infections like tuberculosis, AIDS and fungal infections
  • Cancer that has spread from other parts of the body to the adrenal glands
  • Bilateral Adrenalectomy: a surgery where both adrenal glands are removed
  • Congenital Adrenal Hyperplasia: a condition a person has from birth where the adrenal glands’ ability to make hormones is limited
  • Adrenomyeloneuropathy: An inherited neurological disorder that has adrenal insufficiency as one of its common symptoms.

Secondary Adrenal Insufficiency

In this condition, there is an inadequacy of cortisol in the body, too, but it is caused by a problem with the pituitary gland instead. The pituitary gland produces the adrenocorticotropic hormone (ACTH) which then triggers the adrenal glands to release cortisol. Secondary adrenal insufficiency can be caused by a number of conditions:

  • Pituitary tumor: an abnormal growth of cells in the pituitary gland
  • Sheehan's Syndrome: a condition where the pituitary gland is damaged due to severe blood loss during childbirth
  • Traumatic Head Injury: trauma to the head can damage the pituitary gland as it is located in the brain

People with primary adrenal insufficiency are at a higher risk of having an adrenal crisis than those with secondary adrenal insufficiency.

However, with both kinds of adrenal insufficiency, the chances of adrenal crisis are higher if the condition has gone undiagnosed or is not managed/treated properly.

Discontinuation of Glucocorticoid Medicines

If you’ve been using glucocorticoid medication for a long period of time and you suddenly discontinue using it, you are at risk of having an adrenal crisis as well.

Adrenal Hemorrhage

This is a rare occurrence in which the adrenal gland (or both) hemorrhages (bleeds out). How exactly it happens is currently unknown, but medical hypothesis links it to the adrenal glands reacting to stress caused by conditions and situations like sepsis, burns, trauma, and use of anticoagulants.

There are two types of adrenal hemorrhage: unilateral adrenal hemorrhage (affecting just one adrenal gland) and bilateral adrenal hemorrhage (affecting both glands). Only the bilateral kind of hemorrhage leads to adrenal crisis.

In most cases, there is usually an event to trigger the crisis. Gastrointestinal illness can trigger an adrenal crisis and so can—although less commonly—infections, physical stress, surgical stress, emotional stress, dehydration, and accidents.

Diagnosis

Diagnosing adrenal crisis is usually very difficult as it shares symptoms with many other conditions like sepsis and cardiogenic shock. This difficulty is also worsened by the fact that this is a life-threatening state and any delay in treatment could be fatal.

Some of the tests used to diagnose adrenal crisis are:

  • ACTH Stimulation Test: This test measures the adrenal glands' response to stimulation by ACTH. It checks to see if the adrenal glands will respond appropriately to ACTH by releasing cortisol. It first measures the cortisol levels in the blood, then it gives an injection of ACTH and re-checks the blood cortisol levels.
  • Other blood tests to check the blood sugar levels, cortisol levels, potassium levels, and sodium levels may also be performed.

Diagnosing adrenal crisis during pregnancy is complicated because of the many changes—hormonal and otherwise—that occur. Usually, a doctor will diagnose a pregnant woman with an adrenal crisis when her symptoms are extreme or they come with low blood sugar, salt cravings, or low blood sodium levels.

Treatment

High doses of hydrocortisone (a corticosteroid) is the main treatment for adrenal crisis. The administration of the hydrocortisone can either be intravenous (through a vein) or intramuscular (through a muscle).

Intravenous fluids (IVF) are also given to help with the dehydration and low blood pressure.

After the crisis is under control, treatment for the underlying infection or condition that triggered the adrenal crisis (if any) will be started.

Coping

If you have been diagnosed with adrenal insufficiency or have had adrenal crisis in the past, you should always wear or carry a medical card or tag that says you have adrenal insufficiency. It is especially useful in ensuring that you get the right treatment if you experience an adrenal crisis.

For example, if you are unconscious during an emergency in which you are brought to the hospital without the card or tag, valuable time will be wasted trying to diagnose you or even trying to treat you for another condition with similar symptoms.

As instructed by your doctor, you may need to be prepared to increase your intake of glucocorticoids or receive an emergency shot when you’re in situations of high stress—whether it’s physical or emotional.

If your child has adrenal insufficiency, as a parent, you should be watchful for signs of stress and always be ready to give an emergency shot of glucocorticoids or to increase the dosage or oral glucocorticoids accordingly.

More Tips

It's a good idea to keep in mind the following tips if you are at risk of adrenal crises:

  • Always have your glucocorticoid (usually hydrocortisone) on you at all times.
  • Ask your doctor to show you the proper technique for intramuscular injection of the glucocorticoids.
  • If it is your child who has adrenal insufficiency or has previously suffered an adrenal crisis, ensure that his/her teachers, as well as the school administrator, are aware of this in case of emergencies.
  • If possible, confirm that the school nurse is able to properly administer shots of glucocorticoids should it becomes necessary.

A Word From Verywell

Adrenal crisis is a life-threatening and potential occurrence. If you have any form of adrenal insufficiency, you should make sure that you and the people around you are adequately prepared for its possible occurrence. Preparedness during these situations is key in managing any emergencies that may arise. In addition, your readiness can help you rest assured that you are maintaining your health in the best way possible.

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