Adrenal Crisis

Endocrine System


Clinicals - History

Fact Explanation
{"ops":[{"insert":"Introduction"},{"insert":"\n"}]}
{"ops":[{"insert":"Adrenal crisis does not have a universally agreed-on definition or criteria; what is agreed is that it represents the acute onset or worsening of adrenal insufficiency."}]}
{"ops":[{"insert":"Nausea and vomiting"},{"insert":"\n"}]}
{"ops":[{"insert":"Nausea and vomiting are commonly reported symptoms, although in some cases they may indicate an underlying gastroenteritis, rather than being due to the crisis itself."}]}
{"ops":[{"insert":"Muscle cramps"},{"insert":"\n"}]}
{"ops":[{"insert":"Muscle cramps are typically an early herald of an impending crisis. These are thought to be due to electrolyte disturbances."}]}
{"ops":[{"insert":"Rapid symptom progression"},{"insert":"\n"}]}
{"ops":[{"insert":"Adrenal crises tend to progress rapidly, as the onset triggers a vicious cycle of increasing stress. Studies have shown a delay of only 24 hours from first symptoms to a full-blown crisis."}]}
{"ops":[{"insert":"Preceding constitutional symptoms"},{"insert":"\n"}]}
{"ops":[{"insert":"There may be a preceding history of fatigue, lethargy and weight loss. These are due to the chronic glucocorticoid deficiency secondary to underlying undiagnosed adrenal insufficiency."}]}
{"ops":[{"insert":"Presence of trigger factors"},{"insert":"\n"}]}
{"ops":[{"insert":"Sepsis is the most common trigger of adrenal crisis; other triggers include trauma, surgery, pregnancy, heat, and psychological stress, and poor compliance with glucocorticoid therapy.\n\nNote that in 6% to 12% of patients, a trigger cannot be be identified."}]}
{"ops":[{"insert":"Known or underlying adrenal insufficiency"},{"insert":"\n"}]}
{"ops":[{"insert":"Around half of patients have a known history of adrenal insufficiency. This may be primary insufficiency due to adrenal injury via autoimmune disease, tuberculosis, infection, or surgery; or secondary insufficiency due to pituitary failure, e.g. after Sheehan\u0027s syndrome."}]}
{"ops":[{"insert":"Previous glucocorticoid therapy"},{"insert":"\n"}]}
{"ops":[{"insert":"Prolonged glucocorticoid therapy (i.e. doses equivalent to \u22655mg prednisolone over \u22654 weeks) leads to suppression of endogenous steroid production.\n\nThis may occur in patients with asthma, chronic obstructive pulmonary disease (COPD) and chronic autoimmune conditions."}]}
{"ops":[{"insert":"Medications"},{"insert":"\n"}]}
{"ops":[{"insert":"Medications that can precipitate an adrenal crisis include adrenostatic drugs such as etomidate, and ketoconazole; and agents that increase cortisol metabolism, e.g., barbiturates, rifampin, and mitotane."}]}
{"ops":[{"insert":"Introduction"},{"insert":"\n"}]}
{"ops":[{"insert":"Adrenal crisis does not have a universally agreed-on definition or criteria; what is agreed is that it represents the acute onset or worsening of adrenal insufficiency."}]}
{"ops":[{"insert":"Nausea and vomiting"},{"insert":"\n"}]}
{"ops":[{"insert":"Nausea and vomiting are commonly reported symptoms, although in some cases they may indicate an underlying gastroenteritis, rather than being due to the crisis itself."}]}
{"ops":[{"insert":"Muscle cramps"},{"insert":"\n"}]}
{"ops":[{"insert":"Muscle cramps are typically an early herald of an impending crisis. These are thought to be due to electrolyte disturbances."}]}
{"ops":[{"insert":"Rapid symptom progression"},{"insert":"\n"}]}
{"ops":[{"insert":"Adrenal crises tend to progress rapidly, as the onset triggers a vicious cycle of increasing stress. Studies have shown a delay of only 24 hours from first symptoms to a full-blown crisis."}]}
{"ops":[{"insert":"Preceding constitutional symptoms"},{"insert":"\n"}]}
{"ops":[{"insert":"There may be a preceding history of fatigue, lethargy and weight loss. These are due to the chronic glucocorticoid deficiency secondary to underlying undiagnosed adrenal insufficiency."}]}
{"ops":[{"insert":"Presence of trigger factors"},{"insert":"\n"}]}
{"ops":[{"insert":"Sepsis is the most common trigger of adrenal crisis; other triggers include trauma, surgery, pregnancy, heat, and psychological stress, and poor compliance with glucocorticoid therapy.\n\nNote that in 6% to 12% of patients, a trigger cannot be be identified."}]}
{"ops":[{"insert":"Known or underlying adrenal insufficiency"},{"insert":"\n"}]}
{"ops":[{"insert":"Around half of patients have a known history of adrenal insufficiency. This may be primary insufficiency due to adrenal injury via autoimmune disease, tuberculosis, infection, or surgery; or secondary insufficiency due to pituitary failure, e.g. after Sheehan\u0027s syndrome."}]}
{"ops":[{"insert":"Previous glucocorticoid therapy"},{"insert":"\n"}]}
{"ops":[{"insert":"Prolonged glucocorticoid therapy (i.e. doses equivalent to \u22655mg prednisolone over \u22654 weeks) leads to suppression of endogenous steroid production.\n\nThis may occur in patients with asthma, chronic obstructive pulmonary disease (COPD) and chronic autoimmune conditions."}]}
{"ops":[{"insert":"Medications"},{"insert":"\n"}]}
{"ops":[{"insert":"Medications that can precipitate an adrenal crisis include adrenostatic drugs such as etomidate, and ketoconazole; and agents that increase cortisol metabolism, e.g., barbiturates, rifampin, and mitotane."}]}

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