   Sudden penetrating pain in the legs, lower back or    abdomen   Severe vomiting and diarrhea, resulting in dehydratio...
   Meningococcemia & Organisms associated with adrenal crisis e.g    Haemophilus influenzae, Staphylococcus aureus,Strept...
 Serum cortisol: <20 mcg/dL in severe stress  or after ACTH stimulation is indicative of  adrenal insufficiency ACTH tes...
 Chest radiography: Assess for tuberculosis,  histoplasmosis, malignant disease, sarcoid,  and lymphoma. Abdominal CT sc...
 Primary adrenocortical failure : evidence of  infection, infiltrative disease. Secondary adrenocortical insufficiency: ...
   During an addisonian crisis, low blood pressure, low blood glucose,    and high levels of potassium can occur. Specifi...
 Dexamethasone : Used as empiric treatment of  shock in suspected adrenal crisis or insufficiency  until serum cortisol l...
 Endocrinologist Infectious disease specialist Critical care physician Surgeon Corticosteroids & IV fluids are the ma...
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Addisonion crisis

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Addisonion crisis

  1. 1.  Sudden penetrating pain in the legs, lower back or abdomen Severe vomiting and diarrhea, resulting in dehydration Low blood pressure, Unexplained shock, usually refractory to fluid and pressor resuscitation Syncope (loss of consciousness) Hypoglycemia Confusion, psychosis, slurred speech Severe lethargy Hypercalcemia Convulsions Fever Rapid withdrawal of long-term steroid therapy Hyperthermia or hypothermia
  2. 2.  Meningococcemia & Organisms associated with adrenal crisis e.g Haemophilus influenzae, Staphylococcus aureus,Streptococcus pneumonia, fungi Severe physiologic stress Azotemia Anticoagulants, hemorrhagic diathesis Adrenocorticotropin therapy, known primary or secondary adrenocortical insufficiency AIDS Invasive or infiltrative disorders Tuberculosis Prior steroid use Topical steroids : large surface, long periods of use Inhaled steroids : > 8 mg/dl for long time, Fluticasone even at lower dose
  3. 3.  Serum cortisol: <20 mcg/dL in severe stress or after ACTH stimulation is indicative of adrenal insufficiency ACTH test : diagnostic Serum chemistry, ↓Na, ↑K, metabolic acidosis, Hypoglycemia CBC: Anemia, lymphocytosis, and eosinophilia (highly suggestive) Cultures, Infection is a common cause of acute adrenal crisis.
  4. 4.  Chest radiography: Assess for tuberculosis, histoplasmosis, malignant disease, sarcoid, and lymphoma. Abdominal CT scanning: Visualize adrenal glands for hemorrhage, atrophy, infiltrative disorders, and metastatic disease. Electrocardiography
  5. 5.  Primary adrenocortical failure : evidence of infection, infiltrative disease. Secondary adrenocortical insufficiency: atrophy of the adrenals or no histologic evidence at all, especially if due to exogenous steroid ingestion. Appearance of bilateral adrenal hemorrhage may be striking, as if bags of blood are replacing the glands.
  6. 6.  During an addisonian crisis, low blood pressure, low blood glucose, and high levels of potassium can occur. Specific addisonian crisis treatment for these symptoms involves intravenous (IV) injections of: Hydrocortisone Saline Dextrose These addisonian crisis treatments usually bring rapid improvement. 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.
  7. 7.  Dexamethasone : Used as empiric treatment of shock in suspected adrenal crisis or insufficiency until serum cortisol levels are drawn. Hydrocortisone :DOC because of mineralocorticoid activity and glucocorticoid effects Fludrocortisone (Florinef) : mineralocorticoids, . Produces marked sodium retention and increased urinary potassium excretion. Methylprednisolone : 3rd Line, of lack of mineralocorticoid activity, in patients with fluid overload, edema, or hypokalemia
  8. 8.  Endocrinologist Infectious disease specialist Critical care physician Surgeon Corticosteroids & IV fluids are the mainstays of treatment. Other medications, such as pressors (eg, dopamine, norepinephrine) or antibiotics, are administered as clinically indicated.

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