Fast Five Quiz: Adrenal Gland Disorders

Romesh Khardori, MD, PhD

Disclosures

December 11, 2019

The following are important elements in the history of patients with adrenal crisis or adrenal insufficiency:

  • Weakness

  • Pigmentation of skin

  • Weight loss

  • Abdominal pain

  • Salt craving

  • Diarrhea

  • Constipation

  • Syncope

  • Vitiligo

Causes and related conditions include the following:

  • Surgery

  • Anesthesia (eg, etomidate)

  • Volume loss (unmasks, unless bleeding in the adrenals is present)

  • Trauma

  • Asthma (steroid withdrawal)

  • Hypothermia (a consequence, not cause)

  • Alcohol (not well substantiated)

  • Myocardial infarction (unmasks but does not cause)

  • Fever/infection

  • Hypoglycemia (more likely a consequence rather than cause)

  • Pain (unmasks, but does not cause)

  • Psychoses or depression (associated with, but not causative)

  • Exogenous steroid withdrawal

The following should be assessed in patients with suspected adrenal crisis or adrenal insufficiency:

  • Cortisol level/ACTH

  • Complete blood cell count

  • Electrolyte levels

  • Blood urea nitrogen level

  • Creatinine level

  • Serum calcium level

  • Thyroid function

In patients with adrenal crisis, administer hydrocortisone 100 mg IV every 6 hours. During ACTH stimulation testing, dexamethasone (4 mg IV) can be used instead of hydrocortisone to avoid interference with testing of cortisol levels. Administer fludrocortisone acetate (mineralocorticoid) 0.1 mg every day as needed. Mineralocorticoid administration is usually not necessary for treatment of secondary adrenocortical insufficiency. Once the patient stabilizes, usually by the second day, the corticosteroid dose may be reduced and then tapered. Oral maintenance can usually be achieved by the fourth or fifth day.

Always treat the underlying problem that precipitated the crisis. Infectious etiologies commonly precipitate adrenal crisis. Recognition and treatment of causative factors are crucial aspects of managing adrenal hypofunction.

Read more about adrenal crisis.

This Fast Five Quiz was excerpted and adapted from the Medscape Drugs & Diseases articles Suprarenal (Adrenal) Gland Anatomy, Endogenous Cushing Syndrome, Iatrogenic Cushing Syndrome, Primary Aldosteronism, Pheochromocytoma, Adrenal Crisis in Emergency Medicine, and Addison Disease.

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