ENDOCRINE EMERGENCIES : ACUTE

ADRENAL CRISISZULAIKHA FADZIL

INTRODUCTION

• Acute adrenal crisis: rapid & overwhelming intensification of chronic adrenal insufficiency (1° & 2°)• Primary: failure of adrenal glands• Secondary: failure of HPA axis•

HORMONE FUNCTIONS

PRIMARY ADRENAL INSUFFICIENCY

• 90% of the gland must be destroyed for clinical adrenal insufficiency to develop• Most common cause- TB- Autoimmune disease- Thrombosis or

haemorrhage of adrenals

SECONDARY ADRENAL INSUFFICIENCY• depressed adrenocorticotropic

hormone secretion• reduces cortisol production• aldosterone levels remain normal :

preserved stimulation by both the renin-angiotensin axis and potassium• Adrenal sex hormone production is

also preserved• Most common : long- term therapy

with pharmacologic doses of glucocorticoids

ADRENAL CRISIS• SHOCK resistant to IV fluid resuscitation & vasoprerssors• Causes :- Acute destruction of HPA axis / adrenal gland- Acute STRESSORS in primary / secondary adrenal insufficiency• Stressors:- Acute infection (GI infection)- Surgery- Extreme physical activity- Acute severe injury / burns- Cessation of chronic glucocorticoid usage

CLINICAL FEATURES : 1° & 2°