Adrenal Crisis Medication
- Author: Lisa Kirkland, MD, FACP, CNSP, MSHA; Chief Editor: George T Griffing, MD more...
Medication Summary
Corticosteroids are the mainstays of treatment. Other medications, such as pressors (eg, dopamine, norepinephrine) or antibiotics, are administered as clinically indicated.
Corticosteroids
Class Summary
These agents have anti-inflammatory properties and cause profound and varied metabolic effects. They modify the body's immune response to diverse stimuli.
Dexamethasone (Decadron, Baldex, Dexone)
Used as empiric treatment of shock in suspected adrenal crisis or insufficiency until serum cortisol levels are drawn.
Hydrocortisone (Hydrocortone, Hydrocort)
DOC because of mineralocorticoid activity and glucocorticoid effects.
Cortisone (Cortone)
Oral DOC for patients with adrenocortical insufficiency.
Use in patients undergoing moderate stress surgery (eg, vascular bypass, total joint replacement) who can take PO postoperatively.
Fludrocortisone (Florinef)
Acts on renal distal tubules to enhance reabsorption of sodium. Increases urinary excretion of both potassium and hydrogen ions. The consequence of these 3 primary effects, together with similar actions on cation transport in other tissues, appears to account for the spectrum of physiological activities characteristic of mineralocorticoids. Used in adrenal insufficiency. Produces marked sodium retention and increased urinary potassium excretion.
Methylprednisolone (Medrol, Solu-Medrol, Depo-Medrol)
Usually third-line DOC for adrenal crisis because of lack of mineralocorticoid activity.
Consider use in patients with fluid overload, edema, or hypokalemia.
Vasopressors
Class Summary
These agents are potent vasoconstrictors, inotropes and chronotropes. They should be used with caution in conjunction with corticosteroids and intravenous fluid support.
Norepinephrine (Levophed)
For protracted hypotension following adequate fluid-volume replacement. Stimulates beta1- and alpha-adrenergic receptors, which in turn, increases cardiac muscle contractility and heart rate, as well as vasoconstriction. As a result, systemic blood pressure and coronary blood flow increase. After obtaining a response, the rate of flow should be adjusted and maintained at a low-normal blood pressure, such as 80-100 mm Hg systolic, sufficient to perfuse vital organs.
Dopamine (Intropin)
Stimulates both adrenergic and dopaminergic receptors. Hemodynamic effect is dependent on the dose.
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| Timing | Hydrocortisone | Hydrocortisone | Fludrocortisone |
| Routine daily | … | 20 mg PO at 8 am 10 mg PO at 4 pm | 0.1 mg PO at 8 am |
| Day of operation | 10 mg/h continuous infusion | … | … |
| Postoperative day 1 | 5-7.5 mg/h continuous infusion | … | … |
| Postoperative day 2 | 2.5-5 mg/h continuous infusion | … | … |
| Postoperative day 3 | 2.5-5 mg/h continuous infusion or | 40 mg PO at 8 am 20 mg PO at 4 pm | 0.1 mg PO at 8 am |
| Postoperative day 4 | 2.5-5 mg/h continuous infusion or | 40 mg PO at 8 am 20 mg PO at 4 pm | 0.1 mg PO at 8 am |
| Postoperative day 5 | … | 40 mg PO at 8 am 20 mg PO at 4 pm | 0.1 mg PO at 8 am |
| Postoperative day 6 | … | 20 mg PO at 8 am 20 mg PO at 4 pm | 0.1 mg PO at 8 am |
| Postoperative day 7 | … | 20 mg PO at 8 am 10 mg PO at 4 pm | 0.1 mg PO at 8 am |
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