Alternative Names acute adrenal insufficiency, acute hypoadrenalism
Definition An acute adrenal crisis occurs when the adrenal glands suddenly do not work properly.
What is going on in the body? There are two adrenal glands in the body, one on top of each kidney. The outer part of each adrenal gland secretes important hormones. These hormones are called corticosteroids, which most people refer to as steroids. These steroids are important in the body's metabolism and normal functioning. If the adrenal glands do not secrete enough steroids when the body is under stress, the body cannot function normally and severe symptoms can occur.
What are the signs and symptoms of the condition? A sudden adrenal crisis may cause:
coma, which can occur in severe cases that are not treated quickly
What are the causes and risks of the condition? In order for an adrenal crisis to occur, both adrenal glands must stop working well. There are different causes of this condition, including:
suddenly stopping steroid medications, such as prednisone. When a person takes steroid medications for more than a week, the adrenal glands don't have to make their own steroids and they get weak. If this person then suddenly stops taking steroids, the adrenal glands may not be able to make enough steroids if the body is under stress. Stress may take the form of an illness, surgery, or other problem.
What can be done to prevent the condition? A person who has taken steroid medication within the last year and is now off the medication should notify the doctor if he or she is facing significant stress. An extra dose of steroids may be needed when a person is going through stress. For instance, if a person needs surgery, steroids may be given before and after the surgery to prevent problems and help the body to function normally.
Other causes of sudden adrenal crisis are much harder to prevent. Early treatment of certain infections, such as tuberculosis, may prevent some cases.
How is the condition diagnosed? A doctor may suspect this condition after he or she has taken a person's health history and done a physical examination. Blood tests can be used to confirm the diagnosis.
What are the long-term effects of the condition? The primary effects of this condition are shock, coma, and even death. These can usually all be avoided with proper treatment.
What are the risks to others? There is no risk to others.
What are the treatments for the condition? The most important part of treatment is giving the person steroid medication, usually through an intravenous line directly into a vein. Fluids often need to be given through an IV as well. If the cause of the adrenal crisis is an infection, antibiotics may be needed.
What are the side effects of the treatments? Steroids have many side effects, including mood changes and high blood sugar levels. However, these side effects are usually not a problem in people with an adrenal crisis. Antibiotics have many possible side effects. Allergic reactions, stomach upset and other side effects may occur depending on the medication used.
What happens after treatment for the condition? Most people recover and can return to normal activities. A short course of therapy with steroid pills may be prescribed. If the adrenal glands are permanently damaged, steroid pills may be needed for life.
How is the condition monitored? Following an acute adrenal crisis, a doctor closely monitors the symptoms and does frequent physical examinations. Blood tests are also often used.
Author: Adam Brochert, MD Reviewer: eknowhow Medical Review Panel Editor: Dr John Hearne Last Updated: 15/03/2005 Contributors Potential conflict of interest information for reviewers available on request
