Adrenal Crisis

Acute, severe glucocorticoid deficiency caused by either stress in a patient with underlying adrenal insufficiency or sudden discontinuation of glucocorticoids after prolonged glucocorticoid therapy

Clinical presentation

  • Stress - infection, trauma, surgery
  • Vomiting
  • Abdominal pain
  • Hypotension
  • Shock

Management

  • Rehydration - rapid bolus then fluid replacement of 0.9% sodium chloride
  • Steriods - 100mg hydrocortisone IV injection, followed by 24hr hour 200mg hydrocortisone IV infusion or IM hydrocortisone 50mg injection every 6 hours
  • Manage underlying cause/precipitant
  • If in doubt treat as won't do any harm if incorrect diagnosis but can be life-threatening