What is Addisonian Crisis and How is it Treated?

What is Addisonian Crisis?

Addisonian Crisis which is also referred to as adrenal crisis is an extremely serious and potentially fatal pathological condition is caused due to severe insufficiency of adrenal hormones namely mineralocorticoid and glucocorticoid. These hormones are required for numerous body functions. This is a condition which needs emergent medical attention. Addisonian Crisis is different from Addison Disease which also is caused due to adrenal insufficiency in that the former has an acute onset whereas the latter develops over time.[1]

An individual who is under severe stress is more likely to develop Addisonian Crisis than others. Adrenal Insufficiency is of two types primary and secondary. Primary form of adrenal insufficiency results in the affected individual having extremely low levels of cortisol and aldosterone. The primary causes of primary adrenal insufficiency include autoimmune disorders, certain medications, or infections which affect the functioning of the adrenal gland.[1]

Secondary adrenal insufficiency is caused where there is a decreased production of ACTH in the pituitary gland. Traumas to the head, pituitary tumors, and prolonged steroid use are all causative factors for secondary adrenal insufficiency.[1]

Addisonian Crisis results when adrenal insufficiency is left untreated or the affected individual is under extreme stress due to medical illness, upcoming surgery, physical or emotional trauma, or overexertion. Addisonian Crisis results in depleted levels of cortisol which makes it even more dangerous.[1]

Despite Addisonian Crisis posing a serious threat to the life of the individual, it is not that this condition cannot be treated. With proper treatment, the levels of the depleted hormones can all be brought back to normal. According to a report published in the Journal of Clinical Endocrinology & Metabolism, the mortality rate due to Addisonian Crisis is close to about 6% which is relatively high considering that it is a treatable and preventable disease.[1]

The primary presenting features of Addisonian Crisis include severe lethargy and weakness. The mental condition of the individual will also be compromised with him experiencing confusion and psychosis. There will also be a sensation of feeling lightheaded. The blood pressure of the patient also becomes abnormally low along with a high pulse.[2]

The patient may also have high fever with periods of shills and sweating. Ultimately the patient may lose consciousness and may even go into convulsions. This calls for an immediate admission to the emergency room for treatment to prevent the individual from going into a coma.[2]

How is Addisonian Crisis Treated?

In order to administer treatment it is important to get a diagnosis. The symptoms of Addisonian Crisis can be similar to many other conditions and thus an accurate diagnosis is both challenging and necessary. If the patient has a history of being treated for adrenal insufficiency then a blood work to check for cortisol levels can suffice to make a confirmed diagnosis of Addisonian Crisis.[1]

If the patient does not have a history of adrenal insufficiency then the diagnosis becomes challenging and the actual condition may remain undiagnosed until a medical emergency is sounded. Ultimately when Addisonian Crisis is diagnosed the front line approach towards treatment is administration of corticosteroids. This will prevent the adrenal hormonal levels to go much lower than they already are[2]

The steroids will be administered intravenously till the time the vital signs of the patient stabilize and the patient is in a state to be given medications orally. Dexamethasone is the medication of choice given for Addisonian Crisis.[1]

While treating a patient for Addisonian Crisis it is important to first hydrate the individual as the stress of the condition may make him dehydrated. The next step is to get the electrolyte levels back to normal. Once this is accomplished, the sugar and blood pressure levels need to be corrected and normalized.[2]

Once all the parameters have been normalized the underlying cause of the condition need to be identified and a treatment plan devised to prevent recurrence. All the interventions mentioned above take time and the patient may have to spend a few days in the hospital. However, the age and overall health status of the individual also plays a role in determining the overall hospital stay of the patient for treatment of Addisonian Crisis.[2]

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