Acute adrenal insufficiency

Abstract

Acute adrenal insufficiency represents an endocrine emergency that is treated readily by presently available modalities. The clinical manifestations of adrenal failure are due primarily to deficiencies in aldosterone and cortisol. The lack of mineralocorticoid effect results in an inability to retain salt and fluids with subsequent hypovolemia and hypotension. Glucocorticoid deficiency results in generalized symptoms such as gastrointestinal complaints, lassitude, and hypoglycemia. ACTH is increased due to deficient cortisol secretion and contributes to the hyperpigmentation frequently noted in such patients. Although there are many causes of adrenal insufficiency, idiopathic atrophy due to autoimmune disorders is presently the most frequent etiology. Diabetes mellitus, thyroid disorders, and other autoimmune illnesses may be associated with Addison's disease. The diagnosis may be established rapidly by the presence of a low serum cortisol level that does not rise after ACTH stimulation in patients with suspected disease. Dexamethasone, 2 to 4 mg, may be administered intravenously to acutely ill patients without interfering with the rapid ACTH stimulation test. Management consists of 5% glucose in normal saline and glucocorticoid replacement.