Classic Symptoms Of Addisonian Crisis: Causes And Treatment

Addisonian crisis is a serious life threatening condition caused when the adrenal glands stop producing cortisol hormone. Adrenal glands are two important endocrine glands each located on top of kidneys. Adrenal glands produce hormone cortisol which has several vital roles to play in maintaining bodily functions.

Cortisol helps to maintain metabolism of food, regulates blood pressure, blood sugar level, electrolyte balance, and more importantly stress level.

Normally the circulating level of cortisol is more in morning and after meals. Low level of cortisol hormone can cause low blood pressure, tiredness, fainting etc.

Person suffering from Addison’s disease is at risk of developing addisonian crisis, especially, when the demand of cortisol hormone increases with respect to its production in patients suffering from Addison’s disease. This can occur after severe injury, burn, general anesthesia, infection etc. Patient suffering from adrenal crisis need emergency treatment and hospitalization.

Signs And Symptoms Of Addisonian Crisis

Acute adrenal crisis is noted usually during stress period such as during infection, diarrhea, surgery or trauma among people suffering with adrenal insufficiency. The symptoms of addisonian crisis are as follows:

  • Severe weakness and debility.
  • Dizziness and fainting spells.
  • Nausea and vomiting
  • Pain in abdomen
  • Low grade fever
  • Muscle cramps
  • Pain in lower back and legs.
  • Severe low blood pressure.
  • Rapid heart beats
  • Increased sweating
  • Confusion
  • Loss of consciousness
  • Coma

Patient presenting with addisonian crisis are usually in hypotension and altered sensorium. Hypotension usually occurs secondary to hypovolemia.

Causes And Risk Factors Of Addisonian Crisis

Person suffering from Addison’s disease is at greatest risk of developing acute adrenal insufficiency or addisonian crisis. The risk increases even more if Addison’s disease is not well managed. Addison’s disease is a endocrinal disorder in which the adrenal gland produces insufficient amount of cortisol and aldosterone hormone.

The exact cause of Addison’s disease is not clearly understood, but it is believed to be an autoimmune disease and in some people prolonged use of corticosteroid, bleeding in adrenal gland or surgery of adrenal gland can be the cause. Such patients may experience acute addisonian crisis under stressful conditions such as car accident, surgery, severe dehydration, gastrointestinal infection, etc.

Emergency Treatment Of Addisonian Crisis

Addisonian crisis is a medical emergency. Patient needs to be urgently hospitalized. The primary goal of therapy is to rapidly elevate corticosteroid hormone level in the body and to replace the lost sodium and water from the body.

The doctor immediately gives intravenous hydrocortisone injection to increase the level of cortisone hormone in the body. Along with this, patient is also given intravenous fluids to replenish lost salt and water from the body. Once the condition of patient improves, he is put on oral steroids and oral fluids.

Gradually the dose of steroid is reduced to maintenance level. At the same time the precipitating cause is identified and treated. For example if the cause is bacterial infection precipitating the crisis, antibiotics are started.