What is Adrenal Crisis?
The Adrenal Glands which are located on the top of each kidney is responsible for producing a steroid hormone called as cortisol which helps the body to fight off extremely stressful situation. Cortisol also is responsible for an individual having a good bone health. Cortisol is also responsible for a good immune system and also helps with metabolism of the food that an individual takes. Under normal circumstances, the cortisol produced by the adrenal glands is balanced off by the body such that there is no excess of steroid in any way but in some cases where the adrenal glands of an individual is damaged or due to some other condition the body is not able to produce enough cortisol which causes a variety of symptoms and if not treated on time can be potentially life threatening. This inability of the body to produce enough cortisol is termed as Adrenal Crisis. Adrenal Crisis is also known by the name of Addisonian Crisis as it is seen more in patients with a known diagnosis of Addison Disease.
When the body is not able to produce enough cortisol, then it may lead to a variety of symptoms and complications to include weakness, fatigue, and hypotension. These symptoms are magnified if there is a known diagnosis of Addison Disease. Individuals with damaged adrenal glands as a result of a trauma or infection can also develop Adrenal Crisis. In such cases, the individual will have additional symptoms to include sudden onset dizziness, vomiting, and even fainting episodes. Adrenal Crisis is potentially life threatening if not treated on time and the cortisol levels are not brought back to normal levels.
What are the Causes of Adrenal Crisis?
Adrenal Crisis develops when an individual with already damaged or malfunctioning adrenal glands goes through a stressful situation. In such cases, the body needs cortisol to beat the stressful situation which the adrenal gland is not able to produce leading to Adrenal Crisis.
People more at risk for having Adrenal Crisis are those who have a known diagnosis of Addison Disease. Addison Disease is a medical condition in which the immune system of the body accidentally attacks the adrenal glands and damages it. It is a form of an autoimmune disease. Some of the other causes of Addison Disease are prolonged use of prednisone, severe fungal and viral infections, certain types of tumors, excessive use of blood thinners, or any type of surgery on the adrenal gland. Adrenal Crisis can also be triggered by certain traumatic events to include:
- Witnessing or being in a severe car crash
- A severe injury to an extent that the individual goes into a physical shock
- Severe dehydration
- Severe bout of the flu or an infection caused by a stomach virus.
What are the Risk Factors for Adrenal Crisis?
Some of the risk factors for Adrenal Crisis are:
- Known diagnosis of Addison disease is a risk factor for Adrenal Crisis
- A recent surgery on the adrenal glands for some other medical condition
- Damage to the pituitary gland is also a risk factor for adrenal crisis
- Being noncompliant to treatment given for adrenal insufficiency
- Extreme physical trauma or severe stress
- Severe dehydration.
What are the Symptoms of Adrenal Crisis?
Some of the symptoms of Adrenal Crisis are:
- Severe weakness
- Mental confusion
- Skin discoloration with it becoming dark in color
- Sudden onset dizziness
- Abdominal pain
- Sudden onset pain in the lower back or legs
- Appetite loss
- Severe hypotension
- Rashes on the skin
- Profuse sweating
- High heart rate
- Loss of consciousness
- Unintentional weight loss.
How is Adrenal Crisis Diagnosed?
To begin with, the doctor will take a detailed history of the patient. During the history taking if there is mention of some physical trauma or if the patient has had any adrenal surgery, then it may point to an Adrenal Crisis. To confirm this, the doctor may order a few laboratory tests to check the levels of the cortisol in the body which in cases of Adrenal Crisis will be well below the normal limits. Some of the other tests that might be done to confirm the diagnosis of Adrenal Crisis are:
- ACTH Stimulation Test. This is a test in which the doctor will check the levels of cortisol pre and post an ACTH injection.
- Serum potassium test to check the potassium levels
- Serum sodium test to check sodium levels
- Check the levels of sugar in the blood
The results of all of these tests will be compiled and a confirmed diagnosis will be made of Adrenal Crisis.
How is Adrenal Crisis Treated?
Adrenal Crisis is a medical condition that should be treated emergently as it may become potentially life threatening. The best way to treat Adrenal Crisis is to replenish the cortisol. This is done by medications. As soon as Adrenal Crisis is diagnosed, the patient is given a hydrocortisone injection for symptom relief and to increase the cortisol levels in the body.
Once diagnosed with either Addison Disease or Adrenal Crisis, the patient will be given an emergency home kit which will include an injection of hydrocortisone which can be used whenever there is a bout of Adrenal Crisis. The patient is taught how to use the injection.
It is highly recommended that a patient with Adrenal Crisis not travel alone and always have a partner who should also know how to give a hydrocortisone injection with him or her. An emergency kit should also be present in the car so that it can be used if there is Adrenal Crisis while traveling. If there is an Adrenal Crisis attack, then the patient needs to give the injection and go straight to the nearest emergency room for evaluation so that immediate treatment can be started for Adrenal Crisis.
What is the Prognosis of Adrenal Crisis?
The prognosis of Adrenal Crisis is quite good if proper treatment is given. People with adrenal insufficiency usually lead relatively healthy and normal lives with close monitoring of the cortisol levels and knowing what to do in cases of Adrenal Crisis. If Adrenal Crisis is left untreated then it may result in
- Coma or even death.
The risk of getting an Adrenal Crisis may be limited to a certain degree by taking the prescribed medications diligently and following up with the treating physician and monitoring your condition with regular lab checks so that there are fewer and fewer episodes of Adrenal Crisis.
- Mayo Clinic – Adrenal Crisis: https://www.mayoclinic.org/diseases-conditions/addisons-disease/expert-answers/adrenal-crisis/faq-20417461
- National Institutes of Health – Adrenal Insufficiency and Adrenal Crisis: https://www.niddk.nih.gov/health-information/endocrine-diseases/adrenal-insufficiency-addisons-disease/adrenal-crisis
- MedlinePlus – Adrenal Crisis: https://medlineplus.gov/ency/article/000357.htm
- American Association of Clinical Endocrinologists – Adrenal Crisis: https://www.aace.com/disease-state-resources/adrenal-crisis
- EndocrineWeb – Understanding Adrenal Crisis: https://www.endocrineweb.com/conditions/addisons-disease/adrenal-crisis-severe