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Adrenal Crisis Follow-up

  • Author: Lisa Kirkland, MD, FACP, FCCM, MSHA; Chief Editor: George T Griffing, MD  more...
 
Updated: Jun 29, 2016
 

Further Outpatient Care

See the list below:

  • Treat any underlying or precipitating disorder as clinically indicated.
  • Carefully monitor growth and development in pediatric patients.
  • Recommend medical tag or bracelet that alerts emergency personnel to adrenal gland insufficiency.
  • If exposed to chickenpox, prophylaxis with varicella-zoster immune globulin is indicated.
  • If exposed to measles, prophylaxis with immune globulin is indicated.
  • Closely observe for reactivation of tuberculosis in patients with latent disease.
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Further Inpatient Care

See the list below:

  • Admit to ICU as clinically indicated.
    • Perform fluid resuscitation and hemodynamic monitoring as clinically indicated.
    • Monitor serum electrolytes, magnesium, and glucose every 4-6 hours until stable.
    • Search for precipitating cause of crisis (eg, infection, myocardial infarction, unreported exogenous steroid use within 12 mo, autoimmune disorder).
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Inpatient & Outpatient Medications

See the list below:

  • Taper steroid dose as outlined previously (see Medication).
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Complications

See the list below:

  • Immunosuppression
  • Hypertension
  • Salt retention
  • Hypokalemia
  • Weight gain
  • Delayed wound healing
  • Hyperglycemia
  • Metabolic alkalosis
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Prognosis

See the list below:

  • Prognosis is the same as for patients without adrenal insufficiency if the condition is diagnosed and treated appropriately.
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Patient Education

See the list below:

  • Instruct patients regarding the importance of careful attention to health and fluid intake and to double maintenance doses when ill until medical attention is obtained.
  • Avoid exposure to chickenpox or measles; if exposed, seek medical advice without delay.
  • Notify physician or seek medical attention for persistent nausea and vomiting, fatigue, and abdominal pain.
  • For excellent patient education materials, see eMedicineHealth's Thyroid & Metabolism Center and patient education article Anatomy of the Endocrine System.
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Contributor Information and Disclosures
Author

Lisa Kirkland, MD, FACP, FCCM, MSHA Assistant Professor, Department of Internal Medicine, Division of Hospital Medicine, Mayo Clinic; Vice Chair, Department of Critical Care, ANW Intensivists, Abbott Northwestern Hospital

Lisa Kirkland, MD, FACP, FCCM, MSHA is a member of the following medical societies: American College of Physicians, Society of Hospital Medicine, Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

George T Griffing, MD Professor Emeritus of Medicine, St Louis University School of Medicine

George T Griffing, MD is a member of the following medical societies: American Association for the Advancement of Science, International Society for Clinical Densitometry, Southern Society for Clinical Investigation, American College of Medical Practice Executives, American Association for Physician Leadership, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical and Translational Research, Endocrine Society

Disclosure: Nothing to disclose.

Additional Contributors

David M Klachko, MD, MEd Professor Emeritus, Department of Internal Medicine, Division of Endocrinology, Diabetes, and Metabolism, University of Missouri-Columbia School of Medicine

David M Klachko, MD, MEd is a member of the following medical societies: Alpha Omega Alpha, Missouri State Medical Association, American College of Physicians-American Society of Internal Medicine, American Diabetes Association, American Federation for Medical Research, Endocrine Society, Sigma Xi

Disclosure: Nothing to disclose.

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Computed tomographic (CT) scans of the abdomen show normal adrenal glands several months before the onset of hemorrhage (upper panel) and enlarged adrenals 2 weeks after an acute episode of bilateral adrenal hemorrhage (lower panel). The attenuation of the adrenal glands, indicated by arrows, is increased after the acute event. Reproduced from Rao RH, Vagnucci AH, Amico JA: Bilateral massive adrenal hemorrhage: early recognition and treatment. Ann Intern Med. Feb 1 1989;110(3):227-35 with permission from the journal.
Enlarged, dense, suprarenal masses
 
 
 
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