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Acute adrenal insufficiency - Overview of information
Last reviewed: 12.07.2025
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[ Causes of Acute Adrenal Insufficiency
Adrenal or Addisonian crises develop more often in patients with primary or secondary adrenal disease. They are less common in patients without previous adrenal disease.
Decompensation of metabolic processes in patients with chronic adrenal insufficiency, resulting from inadequate replacement therapy against the background of acute infections, injuries, operations, climate change and heavy physical exertion, is accompanied by the development of an acute form of the disease. The development of an Addisonian crisis is sometimes the first manifestation of the disease in latent and undiagnosed Addison's disease, Schmidt's syndrome. Acute adrenal insufficiency constantly threatens patients with bilateral adrenalectomy performed in patients with Itsenko-Cushing's disease and other conditions.
Symptoms of Acute Adrenal Insufficiency
The development of acute adrenal insufficiency for patients with chronic adrenal diseases poses a major threat to life.
An Addisonian crisis is characterized by the development of a prodromal pre-crisis state, when the main signs of the disease are noticeably intensified.
This period occurs in patients with chronic adrenal insufficiency. In cases where adrenal function is suddenly disrupted as a result of hemorrhage, necrosis, clinical symptoms of acute hypocorticism may develop without warning signs. The duration of the Addisonian crisis may vary: from several hours to several days.
Diagnosis of acute adrenal insufficiency
For the diagnosis of acute adrenal insufficiency, anamnestic indications of previously existing adrenal diseases in patients are important. Adrenal crises most often occur in patients with reduced adrenal cortex function in various extreme conditions of the body. Insufficiency of adrenal cortex secretion occurs with primary adrenal damage and secondary hypocorticism caused by decreased ACTH secretion.
Diseases of the adrenal glands include Addison's disease and congenital dysfunction of the adrenal cortex. If the patient has any autoimmune disease: thyroiditis, diabetes mellitus or anemia - one can think about autoimmune Addison's disease. Primary adrenal insufficiency or Addison's disease sometimes develops as a result of tuberculosis.
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Treatment of acute adrenal insufficiency
In acute adrenal insufficiency, it is necessary to urgently use replacement therapy with synthetic drugs of glucocorticoid and mineralocorticoid action, as well as to carry out measures to bring the patient out of the state of shock. Timely treatment leaves more opportunities to bring the patient out of the crisis. The most life-threatening are the first day of acute hypocorticism. In medical practice, there is no difference between a crisis in patients that occurs during an exacerbation of Addison's disease after removal of the adrenal glands, and a comatose state that occurs as a result of acute destruction of the adrenal cortex in other diseases.
Of the glucocorticoid drugs, preference should be given to hydrocortisone in conditions of acute adrenal insufficiency. It is administered intravenously by jet and drip, for this purpose hydrocortisone hemiscutionate or adreson (cortisone) is used.