Acute adrenal crisis (Addisonian crisis) is a medical emergency. It may be precipitated by extensive acute injury to the adrenal glands, or by the development of an acute illness in a patient with chronic, pre-existing hypoadrenalism.


Precipitating conditions may include:

(1) acute infection

(2) trauma

(3) surgery

(4) acute physiologic stress


The patient may have a history of:

(1) an autoimmune endocrine disorder

(2) a previous episode of acute adrenal crisis


Clinical findings:

(1) dehydration

(2) history of recent weight loss and anorexia

(3) hypotension or shock out of proportion to the severity of the precipitating disorder

(4) nausea and vomiting

(5) diarrhea

(6) acute abdominal pain

(7) unexplained fever

(8) hyperpigmentation or vitiligo

(9) weakness, tiredness or fatigue that progresses to somnolence


Laboratory findings;

(1) unexplained hypoglycemia

(2) hyponatremia

(3) hyperkalemia

(4) azotemia (perhaps related to the dehydration)

(5) hypercalcemia

(6) anemia (if associated with hemorrhage into the adrenal glands)

(7) eosinophilia


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