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Adrenal Crisis


The adrenal gland consists of two discrete regions. The adrenal cortex primary produces endogenous steroids. The medulla produces and secretes epinephrine and nor epinephrine (catecholamines). Hypo function of the adrenal cortex (Addison's disease) results in decreased cortisol production. Cortisol is vital in helping the body react to stressful situations. Individuals with decreased cortisol production cannot respond to stress and risk cardiovascular collapse and possible death. Patients taking exogenous steroids may have adrenal medullary suppression with decreased cortisol production and therefore an inability to produce cortisol when stress is encountered. Many health-care providers recommend increasing the level of exogenous steroids before undergoing any stressful procedure.

   1. Shock like symptoms (cardiovascular collapse) 
       a. Hypotension
       b. Bradycardia
       c. Fever
       d. Respiratory depression
   2. Hypercalcemia 
3. Lethargy

   1. Terminate treatment

   2. Monitor and record vital signs

   3. Place patient in Trendelenburg's position

   4. Assess and support airway, breathing, and circulation- 
       basic life support (BLS)

   5. Provide supplemental oxygen

   6. Start IV hydration with normal saline or D5NSS

   7. Administer supplemental hydrocortisone IV or IM

   8. Transport patient to nearest hospital emergency room.



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