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Addisonian crisis (Triggers (Trauma, Iatrogenic Surgery, Infection e.g.…
Addisonian crisis
Triggers
Trauma
Iatrogenic
Surgery
Infection
e.g. sepsis
Drugs
Missed medication i.e. hydrocortisone
Vascular
Bilateral adrenal haemorrhage
Clinical
presentation
Syncope
Weakness
Confusion
Coma
Pathophysiology
Patient with known Addison's disease
Trigger causes acute decline
in corticosteroids +/- mineralocorticoids
Can lead to severe hypovolemic shock
Diagnosis
Examination
General - pale, unwell
Cardio - tachy
Neuro - reduced GCS, confusion, weak
Investigations
Bedside
Obs - high HR, low BP (shock),
fever if infection
ECG - sinus tachy, hyper-K+
BM - hypoglycaemic
Bloods
FBC (infection), CRP/ESR (infection),
U+E (hyper-K+, hypo-Na, high urea)
LFTs, blood cultures (infection)
Hormones (ACTH high, cortisol low,
aldo/renin may be low)
Urine
Dipstick, MCS (infection)
Imaging
CXR - infection
CT abdo - detect haemorrhage
History
HPC - precipitants, symptoms, onset
PMH: Addison's, other autoimmune, surgery
DH: steroids, allergies
FH: Addisons, autoimmune
SH: smoking, alcohol, travel
Management
Initial ABCDE
Definitive
Medical
Treat hyper-K+
Salbutamol nebs
Calcium gluconate
IV insulin + dextrose
Calcium resonium
Treat hypo-Na
IV 0.9% NaCl
Treat low corticosteroids
IV hydrocortisone 100mg stat
Treat low mineralocorticoids
Inidcation: mineralocorticod deficiency
E.g. fludrocortisone
Conservative
Identify cause
Monitor BMs
Monitor ECG (hyper-K+)
Definition
Endocrine disorder of severe
corticosteroid deficiency often
in patient with known Addison's