adrenal crisis in wilde

1. Adrenal CrisisAdrenal Crisis
Nicole WildeNicole Wilde
UNC Morning ReportUNC Morning Report
5/18/105/18/10

2. Adrenal Crisis: Acute AdrenalAdrenal Crisis: Acute Adrenal
InsufficiencyInsufficiency
 Primary Adrenal InsufficiencyPrimary Adrenal Insufficiency
– Serious infectionSerious infection
– Acute stress in previously undiagnosed casesAcute stress in previously undiagnosed cases
– No extra glucocorticoid therapy duringNo extra glucocorticoid therapy during
infectioninfection
– Abrupt withdrawal from glucocorticoidsAbrupt withdrawal from glucocorticoids
 Bilateral adrenal infarctionBilateral adrenal infarction
 Bilateral adrenal HemorrhageBilateral adrenal Hemorrhage

3. Signs/SymptomsSigns/Symptoms
 ShockShock
 AnorexiaAnorexia
 Nausea/VomitingNausea/Vomiting
 Abdominal PainAbdominal Pain
 Weakness/FatigueWeakness/Fatigue
 FeverFever
 Confusion/ComaConfusion/Coma

4. Bilateral Adrenal Hemorrhage orBilateral Adrenal Hemorrhage or
InfarctionInfarction
 Before CT was diagnosed on autopsyBefore CT was diagnosed on autopsy
 Look for hyperkalemia, hyponatremia, andLook for hyperkalemia, hyponatremia, and
occult hemorrhageoccult hemorrhage
 Risk FactorsRisk Factors
– Anticoagulant therapyAnticoagulant therapy
– CoagulopathyCoagulopathy
– Post operative StatePost operative State
– Meningococcemia or Pseudmonas (sepsis)Meningococcemia or Pseudmonas (sepsis)

5. Pituitary ApoplexyPituitary Apoplexy
 Adrenal crisis is rare with pituitary orAdrenal crisis is rare with pituitary or
hypothalamic adrenal insufficiencyhypothalamic adrenal insufficiency
– Hypovolemia rare due to normal Renin-Hypovolemia rare due to normal Renin-
agiotensin-aldosterone systemagiotensin-aldosterone system
 Crisis can occur with Pituitary infarctCrisis can occur with Pituitary infarct
– Acute cortisol deficiencyAcute cortisol deficiency

6. Chronic 1° Adrenal InsufficiencyChronic 1° Adrenal Insufficiency
 Glucocorticoid, mineralocorticoid, andGlucocorticoid, mineralocorticoid, and
androgen deficiency (women)androgen deficiency (women)
 DehydrationDehydration
 HyperpigmentationHyperpigmentation
 HyperkalemiaHyperkalemia
 Secondary and Tertiary adrenalSecondary and Tertiary adrenal
insufficiency have normalinsufficiency have normal
mineralocorticoid functionmineralocorticoid function

7. DiagnosisDiagnosis
 Random CortisolRandom Cortisol
 Acute ACTH Stimulation TestAcute ACTH Stimulation Test
 Determine cause: CT abdomen, MRIDetermine cause: CT abdomen, MRI
Head, Rule out sepsis, look forHead, Rule out sepsis, look for
autoimmune disease, etc.autoimmune disease, etc.

8. TreatmentTreatment
 Treat HypotensionTreat Hypotension
 Reversal of Electrolyte AbnormalitiesReversal of Electrolyte Abnormalities
 IVFIVF
 Dexamethasone if measuring cortisolDexamethasone if measuring cortisol
 Hydrocortisone for no biochemical testsHydrocortisone for no biochemical tests
 FludocortisoneFludocortisone

9. The EndThe End

10. The EndThe End