Adrenal Crisis (Addisonian Crisis)

Adrenal crisis is a life threatening emergency in patients with primary (classic addisonian crisis), or secondary adrenal failure.  It is often precipitated by stress, surgery or intercurrent illness such as infection or MI due to an inadequate glucocorticoid response.

Although patients with secondary adrenal insufficiency may suffer from adrenal crisis, they usually do not have the same degree of volume depletion, because their renin–angiotensin– aldosterone axis is intact.

Diagnosis – This is often difficult as the patient may have vague symptoms and just appear “unwell”, or symptoms are presumed to be part of the presenting illness.  It is important to consider this diagnosis and have a low index of suspicion.  Patients with adrenal insufficiency often have an alert bracelet or an alert on their patient notes.

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