Adrenal Crisis
common causes:
- addison's disease
- chronic steroid use
- Waterhouse-Friedrichson syndrome (adrenal infarction due to DIC)
- Pituitary apoplexy (pit infarction esp post partum, DIC)
- Oncology - checkpoint inhib immunotherapy
- Look for precipitants: -infection, trauma, pregnancy, reduced steroid use. Initiation of carbamazepine, etomidate, phenytoin etc
presentation:
- Vasodilatory shock esp refractory to fluid
- N,V, abdo pain, fever, delirium
Investigations:
- low Na+, high K+, low Glu
**NB - It is a Dx of exclusion. Rapid response to steroid is supportive of Dx
Management:
- look for triggers and treat
- hydrocortisone esp if known adrenal insufficiency
- dexamethasone - ??? esp if not known insufficiency - check
- supportive