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Addisonian Crisis Management

Acute adrenal insufficiency emergency: hydrocortisone, fluids, electrolytes.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Endokrinoloji department. Book Appointment →

What is Addisonian Crisis Management?

An Addisonian crisis is the acute decompensated form of primary adrenal insufficiency in which the adrenal cortex cannot meet physiological demand for cortisol and aldosterone.

It typically occurs in patients with known Addison disease, secondary adrenal insufficiency, congenital adrenal hyperplasia or those on long-term glucocorticoid therapy when the dose is not increased during stress.

Common precipitants include infection, surgery, trauma, vomiting that prevents oral steroid intake, abrupt steroid withdrawal, myocardial infarction or pregnancy.

Symptoms

Severe hypotension or shock unresponsive to fluids alone
Nausea, vomiting, abdominal pain that may mimic an acute abdomen
Severe weakness, fatigue and confusion
Hyperpigmentation of skin creases and oral mucosa in primary disease
Hyponatraemia, hyperkalaemia (in primary disease) and hypoglycaemia
Random cortisol below 5 µg/dL during physiological stress
Mild metabolic acidosis, hypercalcaemia and eosinophilia

Risk Factors

Known Addison disease or chronic adrenal insufficiency
Chronic glucocorticoid therapy with abrupt withdrawal
Bilateral adrenal haemorrhage (Waterhouse-Friderichsen syndrome)
Autoimmune polyendocrine syndromes
Adrenoleukodystrophy
Pituitary surgery, radiotherapy or apoplexy
Severe infection, surgery, trauma or pregnancy without sick-day dosing

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Patients with adrenal insufficiency must seek emergency care for any febrile illness, vomiting or trauma
  • Inability to take oral steroid (vomiting, severe diarrhoea) requires immediate intramuscular hydrocortisone and emergency department evaluation
  • Sudden severe weakness, dizziness or syncope in a known patient is a medical emergency
  • Confusion, drowsiness or seizures should prompt immediate hospital transfer

Treatment Methods

01
Hydrocortisone 100 mg intravenous bolus, then 50 mg every 6 hours or 200 mg/24 h infusion
02
Aggressive intravenous resuscitation with 1-2 L of 0.9% saline or 5% dextrose-saline in the first hour
03
Correction of hypoglycaemia with concentrated dextrose if needed
04
Treatment of the precipitating illness (antibiotics for sepsis, source control)
05
Hourly monitoring of haemodynamics, electrolytes and glucose
06
Reintroduction of fludrocortisone after taper to maintenance hydrocortisone
07
Patient education: sick-day rules, emergency hydrocortisone injection kit, medical alert bracelet

Which Department to Visit?

You can visit our Endokrinoloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.