Adrenal Crisis in Emergency Medicine Clinical Presentation

  • Author: Kevin M Klauer, DO, FACEP; Chief Editor: Erik D Schraga, MD   more...
 
Updated: Mar 9, 2012
 

History

The following are important elements in the history of patients with adrenal crisis or adrenal insufficiency[3, 4] :

  • 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

  • Surgery
  • Anesthesia (eg, etomidate)
  • Volume loss
  • Trauma
  • Hypothermia
  • Alcohol
  • Myocardial infarction
  • Fever
  • Hypoglycemia
  • Pain
  • Psychoses or depression
  • Exogenous steroid withdrawal
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Contributor Information and Disclosures
Author

Kevin M Klauer, DO, FACEP  Assistant Clinical Professor, Michigan State University College of Osteopathic Medicine; Chief Medical Officer, Emergency Medicine Physicians, Ltd; Director, Center for Emergency Medical Education; Editor-in-Chief, Emergency Physicians Monthly, EJD from Concord Law School, 2011

Kevin M Klauer, DO, FACEP is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Erik D Schraga, MD  Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates

Disclosure: Nothing to disclose.

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

Disclosure: Medscape Salary Employment

Howard A Bessen, MD  Professor of Medicine, Department of Emergency Medicine, University of California, Los Angeles, David Geffen School of Medicine; Program Director, Harbor-UCLA Medical Center

Howard A Bessen, MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Erik D Schraga, MD  Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates

Disclosure: Nothing to disclose.

References

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  2. Hahner S, Loeffler M, Bleicken B, et al. Epidemiology of adrenal crisis in chronic adrenal insufficiency - the need for new prevention strategies. Eur J Endocrinol. Dec 2 2009;[Medline].

  3. Hahner S, Loeffler M, Bleicken B, Drechsler C, Milovanovic D, Fassnacht M, et al. Epidemiology of adrenal crisis in chronic adrenal insufficiency: the need for new prevention strategies. Eur J Endocrinol. Mar 2010;162(3):597-602. [Medline].

  4. Ahi S, Esmaeilzadeh M, Kayvanpour E, Sedaghat-Hamedani F, Samadanifard SH. A bulking agent may lead to adrenal insufficiency crisis: a case report. Acta Med Iran. 2011;49(10):688-9. [Medline].

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Regulation of the adrenal cortex.
 
 
 
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