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Acute Adrenal Crisis

Overview

An abrupt, life-threatening state caused by insufficient cortisol, a hormone produced and released by the adrenal gland. The incidence is 4 out of 100,000 people.


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Causes

The two adrenal glands are located on top of the kidneys. They consist of the outer portion, called the cortex, and the innerportion, called the medulla. The cortex produces three types of hormones, which are called corticosteroids. The androgens andestrogens affect sexual development and reproduction. The glucocorticoids maintain glucose regulation, suppress the immuneresponse, and provide for the response to stress (cortisol). The mineralocorticoids regulate sodium and potassium balance(aldosterone--see the aldosterone test). These hormones are essential for life.Acute adrenal crisis is an emergency caused by decreased cortisol. The crisis may occur in a person with Addison's disease, oras the first sign of adrenal insufficiency . More uncommonly, it may be caused by a pituitary gland disorder. It may also becaused by sudden withdrawal of corticosteroids, removal or injury of the adrenal glands, or destruction of the pituitary gland.Risk factors are stress, trauma, surgery, or infection in a person with Addison's disease, or injury or trauma to the adrenalglands or the pituitary gland.


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Signs & Symptoms

 headache- profound weakness- fatigue- slow, sluggish, lethargic movement- nausea- vomiting- low blood pressure- dehydration- high fever- chills shaking- confusion or coma- darkening of the skin (see skin, abnormally dark or light)- rapid heart rate- joint pain- abdominal pain- unintentional weight loss- rapid respiratory rate (see tachypnea)- unusual and excessive sweating on face and/or palms- skin rash or lesion may be present- flank pain- appetite, loss

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Prevention

People who have Addison's disease should be taught to recognize signs of potential stress that may precipitate an acute adrenalcrisis (cause it to occur suddenly and unexpectedly). Most people with Addison's disease are taught to give themselves anemergency injection of hydrocortisone in times of stress. It is important for the individual with Addison's disease to alwayscarry a medical identification card that states the type of medication and the proper dose needed in case of an emergency. Neveromit medication. If unable to retain medication due to vomiting, notify the health care provider.


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Treatments
Antibiotic Therapy Modern Medicine

Antibiotics are given iv or im in case of sever infection

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