Adrenal crisis is a constellation of symptoms that indicate severe adrenal insufficiency. This may be the result of either previously undiagnosed Addison's disease. Adrenal crisis refers to overwhelming and life-threatening adrenal insufficiency. The most common signs of adrenal crisis are shock (very low blood pressure with a loss of consciousness), dehydration, and an imbalance of sodium and potassium levels in the body.

Causes for acute adrenal crisis

• Stress - Acute adrenal crisis precipitated by infection, trauma, surgery, emotional turmoil, or other stress factors.
• Bilateral adrenal hemorrhage- it may occur as a complication of bacterial infection with Meningococcus or Pseudomonas species, as in Waterhouse-Friderichsen syndrome.
• Bilateral adrenal artery emboli and bilateral vein thrombosis
• Bilateral adrenalectomy
• Untreated, an Addisonian crisis can be fatal. It is a medical emergency, usually requiring hospitalization.

Clinical features

• Sudden penetrating pain in the legs, lower back or abdomen
• Severe vomiting and diarrhea, resulting in dehydration
• Low blood pressure
• Syncope (loss of consciousness)
• Hypoglycemia
• Confusion, psychosis, slurred speech
• Severe lethargy
• Hypercalcemia
• Convulsions
• Fever

Tests and diagnosis

• Hypercalcemia
• Hypoglycemia
• Hyponatraemia
• Hyperkalemia
• Eosinophilia and lymphocytosis
• CT scan- CT abdomen may be normal but may show bilateral enlargement of the adrenal glands in patients with Addison disease because of TB, fungal infections, adrenal hemorrhage, or infiltrating diseases involving the adrenal glands.

Management of Addisonian crisis

During an addisonian crisis, low blood pressure, low blood glucose, and high levels of potassium can be life threatening.

Standard therapy involves intravenous injections of hydrocortisone, saline (salt water), and dextrose (sugar).

When the patient can take fluids and medications by mouth, the amount of hydrocortisone is decreased until a maintenance dose is achieved.

If aldosterone is deficient, maintenance therapy also includes oral doses of fludrocortisone acetate.