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Adrenal Crisis - #MEDSHED

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💀 Adrenal Crisis - #MEDSHED



🌊 Pathogenesis


Adrenal crisis is a life-threatening medical emergency secondary to adrenal insufficiency (lack of gluco- or mineralcorticoid secretion from adrenal cortex)



Primary: failure of adrenal gland


Autoimmune, infection, genetic, etc.


Secondary: impaired stimulation via ACTH or CRH


Tumor, iatrogenic, vascular, etc.



Adrenal crisis should be treated with strong clinical suspicion rather than waiting for confirmatory labs



👀 Treatment


Address underlying/precipitating etiology


Corticosteroid non-compliance, infections, infarcts, drug-induced, etc.



Fluid resuscitation


Reverse volume depletion and Na deficiency


NS (Na 154 mEq/L) or LR (Na 130 mEq/L)


Risk of osmotic demyelination syndrome (ODS) with overcorrection of severely low Na



Corticosteroid replacement


Hydrocortisone 100 mg IV/IM, then 50 mg IV/IM every 6 hours until patient can tolerate orals


Avoid dexamethasone since it doesn’t have mineralcorticoid properties



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