Adrenal Crisis: An Emergent Conditions-An Updated Review for Emergency Medical Services
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Abstract
Background: Adrenal crisis, also known as Addisonian crisis, is a life-threatening condition resulting from acute adrenal insufficiency, characterized by insufficient cortisol production. It is associated with a mortality rate of 0.5 per 100 patient-years and remains a significant cause of death in individuals with adrenal insufficiency. Early recognition and prompt treatment are critical to improving outcomes.
Aim: This review aims to provide an updated understanding of adrenal crisis, including its pathophysiology, etiology, epidemiology, risk factors, diagnostic evaluation, and management strategies, with a focus on improving outcomes through timely intervention and patient education.
Methods: The review synthesizes current literature on adrenal crisis, focusing on its clinical presentation, diagnostic criteria, and treatment protocols. Key aspects such as the role of glucocorticoids, precipitating factors, and preventive strategies are discussed.
Results: Adrenal crisis is often triggered by infections, physical or emotional stress, and medication nonadherence. Laboratory findings include hyponatremia, hyperkalemia, hypoglycemia, and elevated ACTH levels in primary adrenal insufficiency. Immediate administration of hydrocortisone is the cornerstone of treatment, with continuous infusion showing superior outcomes compared to intermittent boluses. Patient education on sick day rules and the use of emergency hydrocortisone kits are essential for prevention.
Conclusion: Adrenal crisis is a medical emergency requiring prompt recognition and treatment. A multidisciplinary approach involving endocrinologists, intensivists, and pharmacists is crucial for optimal management. Enhanced patient education and adherence to preventive measures can significantly reduce morbidity and mortality.