Adrenal Crisis in Emergency Medicine Medication
- Author: Kevin M Klauer, DO, EJD, FACEP; Chief Editor: Romesh Khardori, MD, PhD, FACP more...
One of the goals in treating adrenal insufficiency is glucocorticoid replacement. Electrolyte and metabolic abnormalities, as well as hypovolemia, must also be corrected. In addition, address the event precipitating abrupt decompensation.
These agents are primarily used to correct glucocorticoid deficiencies. The drugs of choice are hydrocortisone, cortisone, and prednisone.
DOC because of mineralocorticoid activity and glucocorticoid effects.
Considered the DOC by some practitioners.
Treats various diseases including adrenocortical insufficiency. Agent is inactive and must be metabolized to active metabolite prednisolone. Conversion may be impaired in patients with liver disease.
Alternative to hydrocortisone to avoid interference with testing of cortisol levels.
Partial replacement therapy for primary and secondary adrenocortical insufficiency.
Wyngaarden JB, Smith LH, Bennett JC. Adrenocortical hypofunction. Cecil Textbook of Medicine. 19th ed. WB Saunders; 1992. 1271-1288.
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. 2009 Dec 2. [Medline].
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. 2010 Mar. 162(3):597-602. [Medline].
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].
Lundy JB, Slane ML, Frizzi JD. Acute adrenal insufficiency after a single dose of etomidate. J Intensive Care Med. 2007 Mar-Apr. 22(2):111-7. [Medline].
[Guideline] Marik PE, Pastores SM, Annane D, et al. Recommendations for the diagnosis and management of corticosteroid insufficiency in critically ill adult patients: consensus statements from an international task force by the American College of Critical Care Medicine. Crit Care Med. 2008 Jun. 36(6):1937-49. [Medline].
Hahner S, Allolio B. Therapeutic management of adrenal insufficiency. Best Pract Res Clin Endocrinol Metab. 2009 Apr. 23(2):167-79. [Medline].
Aono J, Mamiya K, Ueda W. Abrupt onset of adrenal crisis during routine preoperative examination in a patient with unknown Addison's disease. Anesthesiology. 1999 Jan. 90(1):313-4. [Medline].
Braunwald E, Isselbacher KJ, Fauci AS, et al. Hypofunction of adrenal cortex. Harrison's Principles of Internal Medicine. 11th ed. McGraw-Hill; 1987. 1764-1771.
Carson PP. Emergency. Adrenal crisis. Am J Nurs. 2000 Jul. 100(7):49-50. [Medline].
Chin R. Adrenal crisis. Crit Care Clin. 1991 Jan. 7(1):23-42. [Medline].
Cronin CC, Callaghan N, Kearney PJ, et al. Addison disease in patients treated with glucocorticoid therapy. Arch Intern Med. 1997 Feb 24. 157(4):456-8. [Medline].
Dluhy RG. Assessment of systemic corticosteroid activity. Respir Med. 1997 Nov. 91 Suppl A:32-3. [Medline].
Duclos M, Guinot M, Colsy M, Merle F, Baudot C, Corcuff JB, et al. High risk of adrenal insufficiency after a single articular steroid injection in athletes. Med Sci Sports Exerc. 2007 Jul. 39(7):1036-43. [Medline].
Gilliland PF. Endocrine emergencies. Adrenal crisis, myxedema coma, and thyroid storm. Postgrad Med. 1983 Nov. 74(5):215-20, 225-7. [Medline].
Guyton AC, et al. The adrenocortical hormones. Textbook of Medical Physiology. 7th ed. WB Saunders; 1986. 909-919.
Lelubre C, Lheureux PE. Epigastric pain as presentation of an addisonian crisis in a patient with Schmidt syndrome. Am J Emerg Med. 2008 Feb. 26(2):251.e3-4. [Medline].
Omori K, Nomura K, Shimizu S. Risk factors for adrenal crisis in patients with adrenal insufficiency. Endocr J. 2003 Dec. 50(6):745-52. [Medline].
Reincke M. Subclinical Cushing's syndrome. Endocrinol Metab Clin North Am. 2000 Mar. 29(1):43-56. [Medline].
Rosen P. Endocrine disorders. Emergency Medicine: Concepts and Clinical Practice. 3rd ed. Mosby-Year Book; 1992. 2252-2259.
Rusnak RA. Adrenal and pituitary emergencies. Emerg Med Clin North Am. 1989 Nov. 7(4):903-25. [Medline].
Simm PJ, McDonnell CM, Zacharin MR. Primary adrenal insufficiency in childhood and adolescence: advances in diagnosis and management. J Paediatr Child Health. 2004 Nov. 40(11):596-9. [Medline].
Tuchelt H, Dekker K, Bahr V, Oelkers W. Dose-response relationship between plasma ACTH and serum cortisol in the insulin-hypoglycaemia test in 25 healthy subjects and 109 patients with pituitary disease. Clin Endocrinol (Oxf). 2000 Sep. 53(3):301-7. [Medline].
Vesely DL. Hypoglycemic coma: don't overlook acute adrenal crisis. Geriatrics. 1982 May. 37(5):71-3, 76-7. [Medline].
Wiltshire EJ, Wilson R, Pringle KC. Addison's disease presenting with an acute abdomen and complicated by cardiomyopathy. J Paediatr Child Health. 2004 Nov. 40(11):644-5. [Medline].
Puar TH, Stikkelbroeck NM, Smans LC, Zelissen PM, Hermus AR. Adrenal crisis: still a deadly event in the 21st century. Am J Med. 2015 Sep 9. [Medline].
Hahner S, Hemmelmann N, Quinkler M, Beuschlein F, Spinnler C, Allolio B. Timelines in the management of adrenal crisis - targets, limits and reality. Clin Endocrinol (Oxf). 2015 Apr. 82 (4):497-502. [Medline].