Adrenal Crisis Treatment & Management

Updated: Feb 14, 2018
  • Author: Lisa Kirkland, MD, FACP, FCCM, MSHA; Chief Editor: George T Griffing, MD  more...
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Treatment

Medical Care

See the list below:

  • Administration of glucocorticoids in supraphysiologic or stress doses is the only definitive therapy. [13, 14]

    • Dexamethasone does not interfere with serum cortisol assay and, thus, may be the initial drug of choice. However, because dexamethasone has little mineralocorticoid activity, fluid and electrolyte replacement are essential.

    • A short ACTH stimulation test may be performed during resuscitation. Once complete, hydrocortisone 100 mg IV every 6 hours is the preferred treatment to provide mineralocorticoid support.

    • Delaying glucocorticoid replacement therapy while awaiting the results of the ACTH stimulation test is inappropriate and dangerous.

  • In addition to corticosteroid replacement, aggressive fluid replacement with 5% or 10% intravenous dextrose and saline solutions and treatment of hyperkalemia is mandatory. Fludrocortisone, a mineralocorticoid, may also be given.

  • A thorough search for a precipitating cause and administration of empiric antibiotics is indicated. Reversal of coagulopathy should be attempted with fresh frozen plasma.

  • Pressors (eg, dopamine, norepinephrine) may be necessary to combat hypotension.

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Consultations

See the list below:

  • Endocrinologist

  • Infectious disease specialist

  • Critical care physician

  • Cardiologist

  • Surgeon

  • Other consultations as clinically indicated

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