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Potentially life-threatening emergency
Adrenal crisis
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Potentially life-threatening emergency

Adrenal crisis

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Contributors: Shea A. Nagle BA, Benjamin L. Mazer MD, MBA, Marilyn Augustine MD, Michael W. Winter MD
Other Resources UpToDate PubMed

Synopsis

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

Codes

ICD10CM:
E27.2 – Addisonian crisis

SNOMEDCT:
24867002 – Severe adrenal insufficiency

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Reviewed: 05/07/2019
Last Updated: 05/20/2019
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Potentially life-threatening emergency
Adrenal crisis
Print 1 Images
Adrenal crisis : Abdominal pain, Diarrhea, Fever, Hypotension, Nausea/vomiting, Delirium, Hypoglycemia, Na decreased, K increased
Copyright © 2019 VisualDx®. All rights reserved.