An adrenal crisis is a potentially life-threatening condition of mineralocorticoid deficiency in the presence of chronic adrenal insufficiency. Patients with adrenal insufficiency are at risk for adrenal crisis with acute illness or abrupt cessation of steroid medications. The most common precipitating events are gastrointestinal infection, fever, acute stress, and untreated or undertreated adrenal and pituitary disorders.

Adrenal crisis is primarily characterized by shock and hypotension. It may also present with sudden abdominal pain, back or leg pain, nausea, vomiting, diarrhea, a change in mental status or delirium, Addison disease, hyperkalemia, and/or hyponatremia. Other symptoms may include anorexia, weakness, lethargy, hypoglycemia, and coma.

Adrenal crisis accounts for excess mortality in patients with adrenal insufficiency. The incidence of adrenal crisis in patients with adrenal insufficiency on hormone replacement therapy is 5-10 crises per 100 patient years. Patients can decompensate rapidly, with crises evolving within just a few hours after the first symptoms present, making recognition and immediate treatment critical.

Related topics: Addison disease, Secondary adrenal insufficiency