Addisonian crisis or acute adrenal insufficiency is a serious disorder whereby the body is unable to produce certain stress hormones like cortisol. Addisonian crisis is an emergency that warrants immediate treatment by experts like an Internal Medicine Specialist in Lahore. Read on to know more about Addisonian crisis:
What is Addisonian crisis?
The adrenal glands sitting atop the kidneys produce many hormones—including cortisol, aldosterone and adrenaline. These hormones maintain many body functions including blood pressure, electrolyte balance, blood pressure, immune system and even the stress levels. Low levels of any of these hormones disrupts the bodily function with extreme weakness, hypotension and tiredness.
Addisonian crisis occurs when there is acute deficiency of cortisol in the body. This occurs when there is primary or secondary adrenal insufficiency and the adrenals are unable to meet the need of the body. Without treatment, this condition can turn rapidly fatal; in fact, according to data from The Journal of Clinical Endocrinology and metabolism, 6 percent of cases of Addisonian crisis result in death.
What are the causes of Addisonian crisis?
The causes of Addisonian crisis include:
- Injury to the adrenal glands
- Autoimmune disorders
- Cancer metastasis from other parts of the body
- Infections that damage the adrenals—like HIV/AIDS, tuberculosis and fungal infections
- Waterhouse-Friderichsen syndrome—bleeding into the adrenals due to use of blood thinners or toxins
- Amyloidosis—buildup of proteins in the organ
- Surgical removal of the glands
- Genetic illness
- Prolonged use of drugs like glucocorticoids
What are the symptoms of Addisonian crisis?
Addisonian crisis presents with the following symptoms:
- Fever, chills, confusion
- Skin rashes
- Low blood glucose
- Low blood pressures
- Unexplained weight loss
- Craving for salty food
- Dizziness particularly when standing from sitting position
- Muscle weakness
- Patches of dark skin due to raised ACTH
- Cold sensitivity
- Loss of appetite
- Abdominal pain
- Abnormal menstrual cycle
Addisonian crisis is triggered in conditions of stress such as:
- Traumatic event
- Severe dehydration
- Shock due to injury
- Severe infection
- Emotional trauma
- Severe allergic reactions
How is Addisonian crisis diagnosed?
After a thorough history and physical examination, the following investigations are performed for confirmation of diagnosis:
- ACTH stimulation test: this hormone is produced by the pituitary and stimulates the production of cortisol from the adrenals. It is decreased in secondary adrenal insufficiency.
- Serum electrolytes: levels of sodium and potassium must be checked as part of the diagnosis.
- Fasting blood glucose: to check the sugar levels which can run low without adequate cortisol.
- Serum cortisol levels: this test determines the level of cortisol in the body.
- Imaging tests: to check the adrenal glands CT and MRI imaging is used.
What are the treatment options for Addisonian crisis?
For immediate treatment:
- Intravenous corticosteroids are given to the patient
- The patient is rehydrated with intravenous fluids
- Electrolytes levels are checked and balanced
- The goal is to bring the blood glucose and blood pressure back to normal
The mainstay of treatment is:
- Oral hydrocortisone: this is given to replace the cortisol in the blood. The hormones are taken by the patient to mimic the normal 24-hour cycle of cortisol.
- Fludrocortisone: this is the replacement of
How to prevent Addisonian crisis?
Steps can be taken to prevent the complications of Addisonian crisis. These include:
- People should watch out for the symptoms of adrenal insufficiency, especially if an episode has already occurred.
- Patients should take medication as directed by the doctor without skipping any dose.
- Patients should be aware about increasing the dose of medication in case of stress, illness or infection.
- Patients should have extra injections of glucocorticoids on hand in case of emergency.
- Patients should be educated about managing the triggering conditions.
- Patients should go for regular checkups to avoid crisis conditions.
In case of Addisonian crisis, help from the Best Internal Medicine Doctor in Islamabad must be sought as emergency glucocorticoid injection is only intended to stabilize and not substitute medical care.