Survey of adrenal crisis
associated with inhaled corticosteroids in the United Kingdom.
due to adrenal insufficiency [down arrow] Investigations and management Hyperkalemia and hyponatremia (Salt loser) PICU admission Urgent ACTH Stimulation test showed low cortisol, high ACTH, Normal 170HP, low testosterone managed with IV fluids, Hydrocortisone, Kayexalate & Fludrocortisone [down arrow] Final Diagnosis AHC suspected Gene study done DAX-1 mutation [down arrow] Follow-up Thriving well & still prepubertal Will continue monitoring his FSH, LH, testosterone & gonadal development
Acute Management of AI or Adrenal Crisis
. Adrenal crisis
is a life-threatening emergency that requires prompt diagnosis and treatment.
Ito, "A case of aldosterone-producing adrenocortical adenoma associated with a probable post-operative adrenal crisis
: histopathological analyses of the adrenal gland," Hypertension Research, vol.
In clinical practice, the objective of hydrocortisone replacement therapy is to keep doses as low as possible, while trying to avoid symptoms of AI and to minimize the risk of adrenal crisis
. An appropriate increase of HC doses is necessary in situations of physical and mental stress.
Vital signs were stable, but due to the clinical presentation, adrenal crisis
was postulated and methylprednisolone 40 mg intravenously every 8 hours was administered.
Stressors like minor illnesses, surgeries and emotional stresses can push the patient to adrenal crisis
. (10) Acute medical emergencies such as this need prompt diagnosis and management.
Appropriate replacement doses of hydrocortisone (10mg/[m.sup.2]/24hr) (9, 10) twice-daily (2mg in the morning and 1mg at 3pm) was given to prevent an adrenal crisis
and the dose was tapered over two months.
Simultaneous removal of both tumours was not undertaken to minimize the risk of adrenal crisis
. Both patients received cortisone replacement therapy after the second operation.
Historically, the use of intravenous ionic contrast in patients with phaeochromocytomas was guarded, as it could potentially precipitate an adrenal crisis
. However, recent experience shows no adverse events with non-ionic contrast, eliminating the need for premedication.
As many as 90 percent of dogs in adrenal crisis
will have elevated creatinine and BUN, which can lead to a misdiagnosis of acute renal failure.