adrenal crisis
Symptoms
- tachycardic, hypotensive, may need pressors
Diagnosis
- Low Na, high K
- Na 130s, K > 5
- primary adrenal insufficiency
- secondary adrenal insufficiency:
- exogenous steroids
- pituitary surgery, radiation, trauma
- pituitary mass
- hypophysitis: checkpoint inhibitors
Treatment
- stress dose hydrocortisone: stress dose steroid
- taper off as soon as possible based on clinical status
- avoid discharging pt on exogenous steroids unless they have insufficiency
Backlinks
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Primary Adrenal Insufficiency
Primary Adrenal Insufficiency
Causes
- autoimmune
- cancer mets/lymphoma
- infection
- bleeding, infarct
- adrenoleukodystrophy
- CAH
Workup
- low cortisol, high ACTH, can use Cosyntropin stimulation test
- most common cause: autoimmune adrenalitis
- destruction of all layers of adrenal cortex
- positive 21-hydroxylase antibodies in 90% of case