Adrenal Crisis in Emergency Medicine Clinical Presentation

Updated: Apr 04, 2017
  • Author: Kevin M Klauer, DO, EJD, FACEP; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Presentation

History

The following are important elements in the history of patients with adrenal crisis or adrenal insufficiency [6, 7] :

  • Weakness (99%)
  • Pigmentation of skin (98%)
  • Weight loss (97%)
  • Abdominal pain (34%)
  • Salt craving (22%)
  • Diarrhea (20%)
  • Constipation (19%)
  • Syncope (16%)
  • Vitiligo (9%)
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Physical

Physical findings in patients with adrenal insufficiency are subtle and nonspecific.

  • Patients with mineralocorticoid insufficiency may show signs of sodium and volume depletion (eg, orthostatic hypotension, tachycardia).
  • Evidence of hyperpigmentation is observed, particularly in areas exposed to the sun or areas subject to friction or pressure.
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Causes

Causes and related conditions include the following:

  • Surgery
  • Anesthesia (eg, etomidate)
  • Volume loss (unmasks, unless there is bleeding in the adrenals)
  • Trauma
  • Asthma (steroid withdrawal)
  • Hypothermia (a consequence, not cause)
  • Alcohol (not well substantiated)
  • Myocardial infarction (unmasks but does not cause)
  • Fever/infection: In the aforementioned study from the Netherlands, Smans et al found that among patients with adrenal insufficiency, the existence of comorbidity is the most important risk factor for adrenal crisis, with infections being the most common precipitating factors [4]
  • Hypoglycemia (more likely a consequence rather than cause)
  • Pain (unmasks, but does not cause)
  • Psychoses or depression (associated with, but not causative)
  • Exogenous steroid withdrawal
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