Addisonian Crisis

By

Addisonian crisis remains a significantly underestimated and underrecognized medical emergency, frequently leading to misdiagnosis. 

Addison’s disease is a form of primary adrenal insufficiency, most commonly of autoimmune etiology. Typical clinical features include fatigue, generalized weakness, reduced physical performance, and cutaneous hyperpigmentation.

ICD-10 Code

Description

E27.1

Primary adrenal insufficiency

E27.2

Addisonian crisis

An Addisonian crisis represents a life-threatening endocrine emergency resulting from acute cortisol deficiency. Immediate treatment is essential and must not be delayed for diagnostic confirmation.

Clinical Presentation and Diagnosis

Patients may present with hypotension or shock, vomiting, abdominal pain, altered mental status, and electrolyte disturbances.

The diagnosis in the acute setting is primarily clinical, particularly in patients with known or suspected adrenal insufficiency. Therapy must be initiated before laboratory testing, including the ACTH stimulation test.

Acute Management of Addisonian Crisis

Immediate action: Activate emergency medical services (112).

Glucocorticoid therapy: Immediate administration of 100 mg hydrocortisone, intravenously or intramuscularly.

Fluid resuscitation: Rapid infusion of 0.9% sodium chloride (normal saline) to correct hypovolemia and hypotension.

Further management: Continuous monitoring in an intensive care setting, identification and treatment of precipitating factors (e.g., infection), and close monitoring of electrolytes and glucose levels.

Diagnostic Evaluation (After Stabilization)

Clinical diagnosis: Based on acute circulatory collapse, gastrointestinal symptoms, and a history or suspicion of adrenal insufficiency.

ACTH stimulation test: The gold standard diagnostic test, performed after recovery, using synthetic ACTH (Synacthen®) with serial cortisol measurements to assess adrenal cortical function.

Laboratory findings: Common abnormalities include hyponatremia, hyperkalemia, and hypoglycemia.

Prevention and Patient Education

Patients with Addison’s disease should always carry an emergency kit containing injectable hydrocortisone and an emergency medical identification card.
During periods of physiological stress (e.g., infection, surgery, trauma), glucocorticoid doses must be increased prophylactically (typically doubled or tripled) to prevent adrenal crisis.

Note: This text provides a concise clinical overview. Any suspicion of an Addisonian crisis requires immediate emergency medical intervention.

Reference: 
Adrenal Crisis https://www.ncbi.nlm.nih.gov/books/NBK499968/

© 2000-2030 Sieglinde W. Alexander. All writings by Sieglinde W. Alexander have a fife year copy right. Library of Congress Card Number: LCN 00-192742 ISBN: 0-9703195-0-9 
 

Comments

Post a Comment

Popular posts from this blog

Schnitzler Syndrome: A Rare Autoinflammatory Disorder

By
Schnitzler syndrome is a rare, chronic autoinflammatory disease characterized by chronic urticaria (hives), recurrent fever, joint pain, and monoclonal gammopathy (abnormal proteins in the blood). First described by Dr. Liliane Schnitzler in 1972 , this condition is often misdiagnosed, leading to years of untreated symptoms before a correct diagnosis is made. The case report, " A 58-Year-Old Woman With Urticaria, Fever, and Joint Pain " , describes a case that closely aligns with my own experience with this challenging disorder. Key Features of Schnitzler Syndrome Schnitzler syndrome presents with a characteristic set of symptoms, though not all patients experience them in the same way: Chronic Urticaria (Hives) – Persistent, non-itchy or mildly itchy red patches that do not respond to antihistamines. Monoclonal Gammopathy (IgM or IgG type) – Abnormal monoclonal immunoglobulin detected in the blood (most commonly IgM ). Recurrent Fever – Unexplained fever episodes, often...
Read more

Acute Flaccid Myelitis (AFM): Understanding the “Polio-like” Illness Affecting the Spinal Cord

By
Acute flaccid myelitis (AFM) is a rare but serious neurological disorder that primarily affects children and results in sudden weakness or paralysis in the limbs. Often referred to as a “polio-like” illness, AFM has drawn growing attention over the past decade due to its similarities with poliomyelitis and its seasonal spikes in reported cases. While AFM remains uncommon, its potential severity—and the uncertainty surrounding its causes—make it an important condition for clinicians, parents, and public health officials to understand. What Is Acute Flaccid Myelitis? AFM is a condition that affects the gray matter of the spinal cord , where it damages motor neurons responsible for muscle movement. This leads to acute, flaccid paralysis , meaning muscles become limp and weak, often without warning. The condition can progress rapidly, and in some cases, the weakness can become long-lasting or even permanent. Although its symptoms resemble those of poliovirus infection, AFM is not cau...
Read more

Dysferlin Protein: Key Roles, Genetic Locations

By
Image
The purpose of this article is to share and discuss the details of a new discovery, which is highlighted within: CRISPR-Cas9: A Breakthrough Tool to Repair the DYSF Gene The dysferlin protein plays an essential role in maintaining the integrity of muscle cell membranes, particularly in tissues that endure significant mechanical stress, such as skeletal and cardiac muscles . Encoded by the DYSF gene , dysferlin is indispensable for repairing damaged cell membranes after injury caused by muscle contraction or external forces. This article explores the main locations where dysferlin is produced, its role in muscle repair, and supportive nutritional and therapeutic strategies for individuals with dysferlin deficiency, such as those affected by dysferlinopathies (e.g., Limb-Girdle Muscular Dystrophy Type 2B or Miyoshi Myopathy). Currently, there is no definitive answer as to why the severity of dysferlin protein expression or depletion varies. Do pathogens play a role in the methylation o...
Read more