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42 - Adrenal Crisis

from Section 9 - Endocrine Emergencies

Published online by Cambridge University Press:  02 November 2023

By
Raymond Hou  and
Daniel Rolston
Edited by
Kaushal Shah  and
Jarone Lee
Edited in association with
Clark G. Owyang  and
Benjamin Christian Renne
Kaushal Shah
Affiliation:
Weill Cornell Medical Center, New York
Jarone Lee
Affiliation:
Massachusetts General Hospital, Boston
Clark G. Owyang
Affiliation:
Weill Cornell Medical Center, New York
Benjamin Christian Renne
Affiliation:
Massachusetts General Hospital, Boston
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Summary

  • Adrenal insufficiency can be either primary, resulting from destruction of the adrenal gland, or secondary, resulting from a deficiency of ACTH (adrenocorticotropic hormone, corticotropin).

  • Adrenal crisis is either the acute development of severe adrenal insufficiency or a rapid deterioration from baseline chronic adrenal insufficiency (which is often insidious) brought on by a stressor.

  • The adrenal gland (made up of cortex and medulla) produces three categories of steroids: glucocorticoids (cortisol), mineralocorticoids (aldosterone) and gonadocorticoids (sex hormones). Aldosterone levels change in response to volume status and sodium intake. Aldosterone maintains sodium and potassium concentration and regulates water balance.

Keywords

cortisolglucocorticoidsmineralocorticoidshypotensionendocrine
Type
Chapter
Information
Practical Emergency Resuscitation and Critical Care , pp. 433 - 442
Publisher: Cambridge University Press
Print publication year: 2023

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References

Annane, BE. Corticosteroids in the treatment of severe sepsis and septic shock in adults: a systematic review. JAMA 2009;301:2362–2375.CrossRefGoogle ScholarPubMed
Fang, F, Zhang, Y, Tang, J, et al. Association of corticosteroid treatment with outcomes in adult patients with sepsis: a systematic review and meta-analysis. JAMA Intern Med 2019;179(2):213–223. https://doi.org/10.1001/jamainternmed.2018.5849CrossRefGoogle ScholarPubMed
Salvatori, R. Adrenal insufficiency. JAMA 2005;294:2481–2488.CrossRefGoogle ScholarPubMed
Torrey, SP. Recognition and management of adrenal emergencies. Emerg Med Clin North Am 2005;23:687–702, viii.CrossRefGoogle ScholarPubMed
Zull, D. Thyroid and adrenal disorders. In: Marx, JA, Hockberger, RS, Walls, RM, et al., eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice, 7th ed. Philadelphia, PA: Mosby Elsevier, 2010.Google Scholar

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