Acute Adrenal Insufficiency

ACUTE adrenal insufficiency or "Addisonian crisis" is a life-threatening event in a patient whose physiological requirement for glucocorticoid and mineralocorticoid steroid hormones exceeds available supply. Prior to the availability of steroid therapy, acute adrenal insufficiency was the culmination of end-stage Addison disease. With an increasing use of maintenance glucocorticoid therapy, acute adrenal insufficiency has become more commonly recognized among patients with bilateral adrenalectomy, hypophysectomy, and in those on long-term glucocorticoid therapy for other disease processes. Precipitating events are various stressful situations—surgery, severe infection, and trauma—where the requirement for corticosteroids is increased and not met by the fixed steroid dosage that the patient is taking. Acute adrenal insufficiency is generally characterized by one or more of the following signs and symptoms1,2: (1) hypotension, (2) nausea and vomiting, (3) severe weakness, (4) hyperthermia, (5) hypoglycemia, and (6) hyponatremia and hyperkalemia. In addition, the intravascular volume depletion secondary to mineralocorticoid deficiency may