Further Outpatient Care
See the list below:
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Treat any underlying or precipitating disorder as clinically indicated.
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Carefully monitor growth and development in pediatric patients.
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Recommend medical tag or bracelet that alerts emergency personnel to adrenal gland insufficiency.
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If exposed to chickenpox, prophylaxis with varicella-zoster immune globulin is indicated.
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If exposed to measles, prophylaxis with immune globulin is indicated.
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Closely observe for reactivation of tuberculosis in patients with latent disease.
Further Inpatient Care
See the list below:
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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).
Inpatient & Outpatient Medications
See the list below:
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Taper steroid dose as outlined previously (see Medication).
Complications
See the list below:
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Immunosuppression
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Hypertension
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Salt retention
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Hypokalemia
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Weight gain
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Delayed wound healing
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Hyperglycemia
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Metabolic alkalosis
Prognosis
See the list below:
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Prognosis is the same as for patients without adrenal insufficiency if the condition is diagnosed and treated appropriately.
Patient Education
See the list below:
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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.
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Avoid exposure to chickenpox or measles; if exposed, seek medical advice without delay.
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Notify physician or seek medical attention for persistent nausea and vomiting, fatigue, and abdominal pain.
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For excellent patient education materials, see eMedicineHealth's Thyroid & Metabolism Center and patient education article Anatomy of the Endocrine System.
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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.
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Enlarged, dense, suprarenal masses
