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vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Treatment"> <div class="vector-toc-text"> <span class="vector-toc-numb">6</span> <span>Treatment</span> </div> </a> <ul id="toc-Treatment-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Outlook" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Outlook"> <div class="vector-toc-text"> <span class="vector-toc-numb">7</span> <span>Outlook</span> </div> </a> <ul id="toc-Outlook-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Epidemiology" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Epidemiology"> <div class="vector-toc-text"> <span class="vector-toc-numb">8</span> <span>Epidemiology</span> </div> </a> <ul id="toc-Epidemiology-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Special_populations" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Special_populations"> <div class="vector-toc-text"> <span class="vector-toc-numb">9</span> <span>Special populations</span> </div> </a> <button aria-controls="toc-Special_populations-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Special populations subsection</span> </button> <ul id="toc-Special_populations-sublist" class="vector-toc-list"> <li id="toc-Geriatrics" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Geriatrics"> <div class="vector-toc-text"> <span class="vector-toc-numb">9.1</span> <span>Geriatrics</span> </div> </a> <ul id="toc-Geriatrics-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Pregnancy" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Pregnancy"> <div class="vector-toc-text"> <span class="vector-toc-numb">9.2</span> <span>Pregnancy</span> </div> </a> <ul id="toc-Pregnancy-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Children" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Children"> <div class="vector-toc-text"> <span class="vector-toc-numb">9.3</span> <span>Children</span> </div> </a> <ul id="toc-Children-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-See_also" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#See_also"> <div class="vector-toc-text"> <span class="vector-toc-numb">10</span> <span>See also</span> </div> </a> <ul id="toc-See_also-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-References" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#References"> <div class="vector-toc-text"> <span class="vector-toc-numb">11</span> <span>References</span> </div> </a> <button aria-controls="toc-References-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle References subsection</span> </button> <ul id="toc-References-sublist" class="vector-toc-list"> <li id="toc-Citations" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Citations"> <div class="vector-toc-text"> <span class="vector-toc-numb">11.1</span> <span>Citations</span> </div> </a> <ul id="toc-Citations-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Sources" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Sources"> <div class="vector-toc-text"> <span class="vector-toc-numb">11.2</span> <span>Sources</span> </div> </a> <ul id="toc-Sources-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Further_reading" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Further_reading"> <div class="vector-toc-text"> <span class="vector-toc-numb">12</span> <span>Further reading</span> </div> </a> <ul id="toc-Further_reading-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-External_links" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#External_links"> <div class="vector-toc-text"> <span class="vector-toc-numb">13</span> <span>External links</span> </div> </a> <ul id="toc-External_links-sublist" class="vector-toc-list"> </ul> </li> </ul> </div> </div> </nav> </div> </div> <div class="mw-content-container"> <main id="content" class="mw-body"> <header class="mw-body-header vector-page-titlebar"> <nav aria-label="Contents" class="vector-toc-landmark"> <div id="vector-page-titlebar-toc" class="vector-dropdown vector-page-titlebar-toc vector-button-flush-left" > <input type="checkbox" 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href="https://ca.wikipedia.org/wiki/Crisi_addisoniana" title="Crisi addisoniana – Catalan" lang="ca" hreflang="ca" data-title="Crisi addisoniana" data-language-autonym="Català" data-language-local-name="Catalan" class="interlanguage-link-target"><span>Català</span></a></li><li class="interlanguage-link interwiki-el mw-list-item"><a href="https://el.wikipedia.org/wiki/%CE%9F%CE%BE%CE%B5%CE%AF%CE%B1_%CE%B5%CF%80%CE%B9%CE%BD%CE%B5%CF%86%CF%81%CE%B9%CE%B4%CE%B9%CE%B1%CE%BA%CE%AE_%CE%BA%CF%81%CE%AF%CF%83%CE%B7" title="Οξεία επινεφριδιακή κρίση – Greek" lang="el" hreflang="el" data-title="Οξεία επινεφριδιακή κρίση" data-language-autonym="Ελληνικά" data-language-local-name="Greek" class="interlanguage-link-target"><span>Ελληνικά</span></a></li><li class="interlanguage-link interwiki-es badge-Q70893996 mw-list-item" title=""><a href="https://es.wikipedia.org/wiki/Crisis_addisoniana" title="Crisis addisoniana – Spanish" lang="es" hreflang="es" data-title="Crisis addisoniana" data-language-autonym="Español" data-language-local-name="Spanish" class="interlanguage-link-target"><span>Español</span></a></li><li class="interlanguage-link interwiki-it mw-list-item"><a href="https://it.wikipedia.org/wiki/Crisi_addisoniana" title="Crisi addisoniana – Italian" lang="it" hreflang="it" data-title="Crisi addisoniana" data-language-autonym="Italiano" data-language-local-name="Italian" class="interlanguage-link-target"><span>Italiano</span></a></li><li class="interlanguage-link interwiki-he mw-list-item"><a href="https://he.wikipedia.org/wiki/%D7%9E%D7%A9%D7%91%D7%A8_%D7%90%D7%93%D7%99%D7%A1%D7%95%D7%A0%D7%99%D7%90%D7%A0%D7%99" title="משבר אדיסוניאני – Hebrew" lang="he" hreflang="he" data-title="משבר אדיסוניאני" data-language-autonym="עברית" data-language-local-name="Hebrew" class="interlanguage-link-target"><span>עברית</span></a></li><li class="interlanguage-link interwiki-ja mw-list-item"><a href="https://ja.wikipedia.org/wiki/%E6%80%A5%E6%80%A7%E5%89%AF%E8%85%8E%E4%B8%8D%E5%85%A8" title="急性副腎不全 – Japanese" lang="ja" hreflang="ja" data-title="急性副腎不全" data-language-autonym="日本語" data-language-local-name="Japanese" class="interlanguage-link-target"><span>日本語</span></a></li><li class="interlanguage-link interwiki-or mw-list-item"><a href="https://or.wikipedia.org/wiki/%E0%AC%86%E0%AC%A1%E0%AD%8D%E0%AC%B0%E0%AD%87%E0%AC%A8%E0%AC%BE%E0%AC%B2_%E0%AC%B8%E0%AC%99%E0%AD%8D%E0%AC%95%E0%AC%9F" title="ଆଡ୍ରେନାଲ ସଙ୍କଟ – Odia" lang="or" hreflang="or" data-title="ଆଡ୍ରେନାଲ ସଙ୍କଟ" data-language-autonym="ଓଡ଼ିଆ" data-language-local-name="Odia" class="interlanguage-link-target"><span>ଓଡ଼ିଆ</span></a></li><li class="interlanguage-link interwiki-pl mw-list-item"><a href="https://pl.wikipedia.org/wiki/Prze%C5%82om_nadnerczowy" title="Przełom nadnerczowy – Polish" lang="pl" hreflang="pl" data-title="Przełom nadnerczowy" data-language-autonym="Polski" data-language-local-name="Polish" 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condition</div><style data-mw-deduplicate="TemplateStyles:r1257001546">.mw-parser-output .infobox-subbox{padding:0;border:none;margin:-3px;width:auto;min-width:100%;font-size:100%;clear:none;float:none;background-color:transparent}.mw-parser-output .infobox-3cols-child{margin:auto}.mw-parser-output .infobox .navbar{font-size:100%}@media screen{html.skin-theme-clientpref-night .mw-parser-output .infobox-full-data:not(.notheme)>div:not(.notheme)[style]{background:#1f1f23!important;color:#f8f9fa}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .infobox-full-data:not(.notheme) div:not(.notheme){background:#1f1f23!important;color:#f8f9fa}}@media(min-width:640px){body.skin--responsive .mw-parser-output .infobox-table{display:table!important}body.skin--responsive .mw-parser-output .infobox-table>caption{display:table-caption!important}body.skin--responsive .mw-parser-output .infobox-table>tbody{display:table-row-group}body.skin--responsive .mw-parser-output .infobox-table tr{display:table-row!important}body.skin--responsive .mw-parser-output .infobox-table th,body.skin--responsive .mw-parser-output .infobox-table td{padding-left:inherit;padding-right:inherit}}</style><table class="infobox ib-medical-condition"><tbody><tr><th colspan="2" class="infobox-above" style="background:#ccc">Adrenal crisis</th></tr><tr><th scope="row" class="infobox-label">Other names</th><td class="infobox-data">Acute adrenal insufficiency, Addisonian crisis, Acute adrenal failure.<sup id="cite_ref-Monarch_Initiative_u386_1-0" class="reference"><a href="#cite_note-Monarch_Initiative_u386-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup></td></tr><tr style="background-color: #f8f9fa;"><td colspan="2" class="infobox-full-data"><span class="mw-default-size" typeof="mw:File/Frameless"><a href="/wiki/File:AdrenalCrisis.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/2/2e/AdrenalCrisis.jpg/220px-AdrenalCrisis.jpg" decoding="async" width="220" height="144" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/2/2e/AdrenalCrisis.jpg/330px-AdrenalCrisis.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/2/2e/AdrenalCrisis.jpg/440px-AdrenalCrisis.jpg 2x" data-file-width="1047" data-file-height="687" /></a></span></td></tr><tr><td colspan="2" class="infobox-full-data">49-year-old male with an adrenal crisis. Appearance, showing lack of facial hair, <a href="/wiki/Dehydration" title="Dehydration">dehydration</a>, <a href="/wiki/Queen_Anne%27s_sign" class="mw-redirect" title="Queen Anne's sign">Queen Anne's sign</a> (panel A), <a href="/wiki/Pallor" title="Pallor">pale skin</a>, muscular and <a href="/wiki/Weight_loss" title="Weight loss">weight loss</a>, and loss of body hair (panel B).</td></tr><tr><th scope="row" class="infobox-label">Pronunciation</th><td class="infobox-data"><style data-mw-deduplicate="TemplateStyles:r1126788409">.mw-parser-output .plainlist ol,.mw-parser-output .plainlist ul{line-height:inherit;list-style:none;margin:0;padding:0}.mw-parser-output .plainlist ol li,.mw-parser-output .plainlist ul li{margin-bottom:0}</style><div class="plainlist"><ul><li><span class="rt-commentedText nowrap"><span class="IPA nopopups noexcerpt" lang="en-fonipa"><a href="/wiki/Help:IPA/English" title="Help:IPA/English">/<span style="border-bottom:1px dotted"><span title="/ə/: 'a' in 'about'">ə</span><span title="/ˈ/: primary stress follows">ˈ</span><span title="'d' in 'dye'">d</span><span title="'r' in 'rye'">r</span><span title="/iː/: 'ee' in 'fleece'">iː</span><span title="/./: syllable break">.</span><span title="'n' in 'nigh'">n</span><span title="/əl/: 'le' in 'bottle'">əl</span></span><span class="wrap"> </span><span style="border-bottom:1px dotted"><span title="/ˈ/: primary stress follows">ˈ</span><span title="'k' in 'kind'">k</span><span title="'r' in 'rye'">r</span><span title="/aɪ/: 'i' in 'tide'">aɪ</span><span title="/./: syllable break">.</span><span title="'s' in 'sigh'">s</span><span title="/ɪ/: 'i' in 'kit'">ɪ</span><span title="'s' in 'sigh'">s</span></span>/</a></span></span> </li></ul></div></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medical_specialty" title="Medical specialty">Specialty</a></th><td class="infobox-data"><a href="/wiki/Emergency_medicine" title="Emergency medicine">Emergency medicine</a>, <a href="/wiki/Endocrinology" title="Endocrinology">Endocrinology</a></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Signs_and_symptoms" title="Signs and symptoms">Symptoms</a></th><td class="infobox-data"><a href="/wiki/Dizziness" title="Dizziness">Dizziness</a>, <a href="/wiki/Somnolence" title="Somnolence">somnolence</a>, <a href="/wiki/Confusion" title="Confusion">confusion</a>, <a href="/wiki/Loss_of_consciousness" class="mw-redirect" title="Loss of consciousness">loss of consciousness</a>, <a href="/wiki/Nausea" title="Nausea">nausea</a>, vomiting, <a href="/wiki/Abdominal_pain" title="Abdominal pain">abdominal pain</a>, <a href="/wiki/Anorexia_(symptom)" title="Anorexia (symptom)">decreased appetite</a>, extreme <a href="/wiki/Fatigue" title="Fatigue">exhaustion</a>, unintended <a href="/wiki/Weight_loss" title="Weight loss">weight loss</a>, <a href="/wiki/Weakness" title="Weakness">weakness</a>, and <a href="/wiki/Hypotension" title="Hypotension">hypotension</a>.<sup id="cite_ref-Elshimy_2023_2-0" class="reference"><a href="#cite_note-Elshimy_2023-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Complication_(medicine)" title="Complication (medicine)">Complications</a></th><td class="infobox-data"><a href="/wiki/Seizure" title="Seizure">Seizures</a>, <a href="/wiki/Arrhythmia" title="Arrhythmia">arrhythmias</a>, <a href="/wiki/Organ_dysfunction" title="Organ dysfunction">organ damage</a>, coma, and death.<sup id="cite_ref-Elshimy_2023_2-1" class="reference"><a href="#cite_note-Elshimy_2023-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label">Causes</th><td class="infobox-data"><a href="/wiki/Adrenal_insufficiency" title="Adrenal insufficiency">Adrenal insufficiency</a>, <a href="/wiki/Thyrotoxicosis" class="mw-redirect" title="Thyrotoxicosis">thyrotoxicosis</a>, infections, trauma, pregnancy, and surgery.<sup id="cite_ref-Elshimy_2023_2-2" class="reference"><a href="#cite_note-Elshimy_2023-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Risk_factor" title="Risk factor">Risk factors</a></th><td class="infobox-data"><a href="/wiki/Adrenal_insufficiency" title="Adrenal insufficiency">Adrenal insufficiency</a>, <a href="/wiki/Autoimmune_polyendocrine_syndrome" title="Autoimmune polyendocrine syndrome">polyglandular autoimmune syndromes</a>, <a href="/wiki/Glucocorticoid" title="Glucocorticoid">glucocorticoids</a>, <a href="/wiki/Levothyroxine" title="Levothyroxine">levothyroxine</a>, and <a href="/wiki/Rifampicin" title="Rifampicin">rifampin</a>.<sup id="cite_ref-Elshimy_2023_2-3" class="reference"><a href="#cite_note-Elshimy_2023-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medical_diagnosis" title="Medical diagnosis">Diagnostic method</a></th><td class="infobox-data"><a href="/wiki/Adrenocorticotropic_hormone" title="Adrenocorticotropic hormone">ACTH</a>, <a href="/wiki/Basic_metabolic_panel" title="Basic metabolic panel">basic metabolic panel</a>, and <a href="/wiki/Cortisol" title="Cortisol">cortisol</a>.<sup id="cite_ref-Elshimy_2023_2-4" class="reference"><a href="#cite_note-Elshimy_2023-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Differential_diagnosis" title="Differential diagnosis">Differential diagnosis</a></th><td class="infobox-data"><a href="/wiki/Myocardial_infarction" title="Myocardial infarction">Myocardial infarction</a>, trauma, stress, <a href="/wiki/Myxedema_coma" title="Myxedema coma">myxedema coma</a>, <a href="/wiki/Circulatory_shock" class="mw-redirect" title="Circulatory shock">circulatory shock</a>, <a href="/wiki/Septic_shock" title="Septic shock">septic shock</a>, and infection.<sup id="cite_ref-Elshimy_2023_2-5" class="reference"><a href="#cite_note-Elshimy_2023-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label">Prevention</th><td class="infobox-data">Providing intramuscular <a href="/wiki/Hydrocortisone" title="Hydrocortisone">hydrocortisone</a> at home and using sick day rules.<sup id="cite_ref-Elshimy_2023_2-6" class="reference"><a href="#cite_note-Elshimy_2023-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label">Treatment</th><td class="infobox-data">Steroid replacement and <a href="/wiki/Fluid_resuscitation" class="mw-redirect" title="Fluid resuscitation">fluid resuscitation</a>.<sup id="cite_ref-FOOTNOTEPuarStikkelbroeckSmansZelissen2016339.e5_3-0" class="reference"><a href="#cite_note-FOOTNOTEPuarStikkelbroeckSmansZelissen2016339.e5-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medication" title="Medication">Medication</a></th><td class="infobox-data"><a href="/wiki/Hydrocortisone" title="Hydrocortisone">Hydrocortisone</a>.</td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Prognosis" title="Prognosis">Prognosis</a></th><td class="infobox-data">6% mortality rate.<sup id="cite_ref-FOOTNOTEHahnerSpinnlerFassnachtBurger-Stritt2015407_4-0" class="reference"><a href="#cite_note-FOOTNOTEHahnerSpinnlerFassnachtBurger-Stritt2015407-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label">Frequency</th><td class="infobox-data">6–8% of those with <a href="/wiki/Adrenal_insufficiency" title="Adrenal insufficiency">adrenal insufficiency</a> annually.</td></tr></tbody></table> <p><b>Adrenal crisis</b>, also known as <b>Addisonian crisis</b> or <b>acute adrenal insufficiency</b>, is a life-threatening complication of <a href="/wiki/Adrenal_insufficiency" title="Adrenal insufficiency">adrenal insufficiency</a>. <a href="/wiki/Hypotension" title="Hypotension">Hypotension</a>, and <a href="/wiki/Hypovolemic_shock" title="Hypovolemic shock">hypovolemic shock</a>, are the main symptoms of an adrenal crisis. Other symptoms include <a href="/wiki/Weakness" title="Weakness">weakness</a>, <a href="/wiki/Anorexia_(symptom)" title="Anorexia (symptom)">anorexia</a>, <a href="/wiki/Nausea" title="Nausea">nausea</a>, vomiting, fever, <a href="/wiki/Fatigue" title="Fatigue">fatigue</a>, abnormal <a href="/wiki/Electrolyte" title="Electrolyte">electrolytes</a>, <a href="/wiki/Confusion" title="Confusion">confusion</a>, and coma. Laboratory testing may detect <a href="/wiki/Low_sodium" class="mw-redirect" title="Low sodium">low sodium</a>, <a href="/wiki/High_potassium" class="mw-redirect" title="High potassium">high potassium</a>, <a href="/wiki/Lymphocytosis" title="Lymphocytosis">high lymphocyte count</a>, <a href="/wiki/Eosinophilia" title="Eosinophilia">high eosinophils</a>, <a href="/wiki/Low_blood_sugar" class="mw-redirect" title="Low blood sugar">low blood sugar</a>, and rarely <a href="/wiki/High_calcium" class="mw-redirect" title="High calcium">high calcium</a>. The biggest trigger for adrenal crisis is <a href="/wiki/Gastrointestinal_disease" title="Gastrointestinal disease">gastrointestinal illness</a>. Those with primary adrenal insufficiency are at a higher risk for an adrenal crisis. The physiological mechanisms underlying an adrenal crisis involve the loss of endogenous <a href="/wiki/Glucocorticoid" title="Glucocorticoid">glucocorticoids</a>' typical inhibitory effect on inflammatory <a href="/wiki/Cytokine" title="Cytokine">cytokines</a>. </p><p>When someone with adrenal insufficiency exhibits symptoms of an adrenal crisis, treatment must begin immediately. To diagnose an adrenal crisis, serum <a href="/wiki/Cortisol" title="Cortisol">cortisol</a>, <a href="/wiki/Aldosterone" title="Aldosterone">aldosterone</a>, <a href="/wiki/Adrenocorticotropic_hormone" title="Adrenocorticotropic hormone">ACTH</a>, <a href="/wiki/Renin" title="Renin">renin</a>, and <a href="/wiki/Dehydroepiandrosterone_sulfate" title="Dehydroepiandrosterone sulfate">dehydroepiandrosterone sulfate</a> are measured. A low <a href="/wiki/Cortisol" title="Cortisol">cortisol</a> level of less than 3 mg/dL, measured in the early morning or during a stressful period, suggests a diagnosis of adrenal insufficiency. A tailored prescription, and strategies for administering additional <a href="/wiki/Glucocorticoid" title="Glucocorticoid">glucocorticoids</a> for physiological stress, are critical preventative measures. When someone experiences an adrenal crisis, they require immediate parenteral <a href="/wiki/Hydrocortisone" title="Hydrocortisone">hydrocortisone</a>. About 6–8% of those with adrenal insufficiency experience an adrenal crisis at some point each year. The mortality rate linked to adrenal crises is up to 6%. </p> <meta property="mw:PageProp/toc" /> <div class="mw-heading mw-heading2"><h2 id="Signs_and_symptoms">Signs and symptoms</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Adrenal_crisis&action=edit&section=1" title="Edit section: Signs and symptoms"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>In as many as 50% of those with <a href="/wiki/Addison%27s_disease" title="Addison's disease">Addison's disease</a>, adrenal crisis can be the first indication of <a href="/wiki/Adrenal_insufficiency" title="Adrenal insufficiency">adrenal insufficiency</a>. Diagnosis is often delayed since most of the symptoms of adrenal insufficiency are nonspecific and develop insidiously.<sup id="cite_ref-FOOTNOTEPuarStikkelbroeckSmansZelissen2016339.e2_5-0" class="reference"><a href="#cite_note-FOOTNOTEPuarStikkelbroeckSmansZelissen2016339.e2-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Hypotension" title="Hypotension">Hypotension</a> and <a href="/wiki/Shock_(circulatory)" title="Shock (circulatory)">shock</a> that fail to respond to <a href="/wiki/Vasopressors" class="mw-redirect" title="Vasopressors">vasopressors</a> or fluid resuscitation are the main signs of an adrenal crisis.<sup id="cite_ref-FOOTNOTETucciSokari2014474_6-0" class="reference"><a href="#cite_note-FOOTNOTETucciSokari2014474-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> Those in an adrenal crisis can deteriorate quickly, usually within a few hours.<sup id="cite_ref-FOOTNOTEClaessenAndelaBiermaszPereira20214_7-0" class="reference"><a href="#cite_note-FOOTNOTEClaessenAndelaBiermaszPereira20214-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> Gastrointestinal symptoms such as <a href="/wiki/Nausea" title="Nausea">nausea</a>, <a href="/wiki/Vomiting" title="Vomiting">vomiting</a>, <a href="/wiki/Anorexia_(symptom)" title="Anorexia (symptom)">anorexia</a> and <a href="/wiki/Abdominal_pain" title="Abdominal pain">abdominal pain</a> are common in adrenal insufficiency and can lead to misdiagnosis. Other symptoms of an adrenal crisis include severe <a href="/wiki/Fatigue" title="Fatigue">fatigue</a>, <a href="/wiki/Dizziness" title="Dizziness">dizziness</a>, diffuse limb and <a href="/wiki/Back_pain" title="Back pain">back pain</a>, <a href="/wiki/Malaise" title="Malaise">malaise</a>, and <a href="/wiki/Weakness" title="Weakness">weakness</a>.<sup id="cite_ref-FOOTNOTEClaessenAndelaBiermaszPereira20214_7-1" class="reference"><a href="#cite_note-FOOTNOTEClaessenAndelaBiermaszPereira20214-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-FOOTNOTETucciSokari2014474_6-1" class="reference"><a href="#cite_note-FOOTNOTETucciSokari2014474-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Fever" title="Fever">Fever</a> is a common sign of adrenal crisis resulting from either concurrent illness or the release of <a href="/wiki/Cytokine" title="Cytokine">cytokines</a>. Neurocognitive symptoms can vary from <a href="/wiki/Agitation_Free" title="Agitation Free">agitation</a>, issues with concentration, and <a href="/wiki/Depression_(mood)" title="Depression (mood)">depression</a>, to <a href="/wiki/Delirium" title="Delirium">delirium</a> and <a href="/wiki/Coma" title="Coma">coma</a>.<sup id="cite_ref-FOOTNOTEClaessenAndelaBiermaszPereira20214_7-2" class="reference"><a href="#cite_note-FOOTNOTEClaessenAndelaBiermaszPereira20214-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> </p><p>During an adrenal crisis laboratory testing may show low sodium (<a href="/wiki/Hyponatremia" title="Hyponatremia">hyponatremia</a>), high potassium (<a href="/wiki/Hyperkalemia" title="Hyperkalemia">hyperkalemia</a>), high <a href="/wiki/Lymphocyte" title="Lymphocyte">lymphocyte</a> count (<a href="/wiki/Lymphocytosis" title="Lymphocytosis">lymphocytosis</a>), high <a href="/wiki/Eosinophil" title="Eosinophil">eosinophils</a> (<a href="/wiki/Eosinophilia" title="Eosinophilia">eosinophilia</a>), low blood sugar (<a href="/wiki/Hypoglycemia" title="Hypoglycemia">hypoglycemia</a>), and rarely high calcium (<a href="/wiki/Hypercalcaemia" title="Hypercalcaemia">hypercalcemia</a>).<sup id="cite_ref-FOOTNOTERushworthTorpyFalhammar2020628_8-0" class="reference"><a href="#cite_note-FOOTNOTERushworthTorpyFalhammar2020628-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> In an adrenal crisis, hypotension occurs due to <a href="/wiki/Hypocortisolism" class="mw-redirect" title="Hypocortisolism">low cortisol</a> and <a href="/wiki/Volume_depletion" class="mw-redirect" title="Volume depletion">volume depletion</a>.<sup id="cite_ref-FOOTNOTEDineenThompsonSherlock20195_9-0" class="reference"><a href="#cite_note-FOOTNOTEDineenThompsonSherlock20195-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> Hypovolemia might be resistant to <a href="/wiki/Inotrope" title="Inotrope">inotropes</a> and fluids if it is not identified. In secondary adrenal insufficiency, hyponatremia results from decreased <a href="/wiki/Kidney" title="Kidney">kidney</a> excretion of <a href="/wiki/Electrolyte" title="Electrolyte">electrolyte</a>-free water and the inability to suppress <a href="/wiki/Vasopressin" title="Vasopressin">vasopressin</a>.<sup id="cite_ref-FOOTNOTEPuarStikkelbroeckSmansZelissen2016339.e2_5-1" class="reference"><a href="#cite_note-FOOTNOTEPuarStikkelbroeckSmansZelissen2016339.e2-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> Hyponatremia in primary adrenal insufficiency is caused by concurrent <a href="/wiki/Aldosterone_deficiency" class="mw-redirect" title="Aldosterone deficiency">aldosterone deficiency</a>, resulting in volume depletion, <a href="/wiki/Natriuresis" title="Natriuresis">natriuresis</a>, and hyperkalemia. Hypercalcemia is triggered by decreased calcium excretion and accelerated bone resorption throughout an adrenal crisis, which can be exacerbated by volume depletion. Hypovolemia and hypoglycemia can cause varying degrees of <a href="/wiki/Renal_insufficiency" class="mw-redirect" title="Renal insufficiency">renal insufficiency</a> due to decreased <a href="/wiki/Gluconeogenesis" title="Gluconeogenesis">gluconeogenesis</a>.<sup id="cite_ref-FOOTNOTEClaessenAndelaBiermaszPereira20214_7-3" class="reference"><a href="#cite_note-FOOTNOTEClaessenAndelaBiermaszPereira20214-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Causes">Causes</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Adrenal_crisis&action=edit&section=2" title="Edit section: Causes"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>An adrenal crisis can be caused by <a href="/wiki/Adrenal_insufficiency" title="Adrenal insufficiency">adrenal insufficiency</a>. Adrenal insufficiency can be classified into primary adrenal insufficiency caused by conditions affecting the <a href="/wiki/Adrenal_cortex" title="Adrenal cortex">adrenal cortex</a>, secondary adrenal insufficiency due to <a href="/wiki/Adrenocorticotropic_hormone" title="Adrenocorticotropic hormone">ACTH</a> deficiency caused by conditions affecting the <a href="/wiki/Hypothalamus" title="Hypothalamus">hypothalamus</a> or <a href="/wiki/Pituitary_gland" title="Pituitary gland">pituitary gland</a>, or tertiary adrenal insufficiency caused by excessive glucocorticoid exposure. Adrenal insufficiency can be caused by <a href="/wiki/Autoimmune_disease" title="Autoimmune disease">autoimmune disorders</a> such as <a href="/wiki/Autoimmune_adrenalitis" class="mw-redirect" title="Autoimmune adrenalitis">autoimmune adrenalitis</a>, <a href="/wiki/Autoimmune_polyglandular_syndrome" class="mw-redirect" title="Autoimmune polyglandular syndrome">autoimmune polyglandular syndrome</a>, and <a href="/wiki/Lymphocytic_hypophysitis" class="mw-redirect" title="Lymphocytic hypophysitis">lymphocytic hypophysitis</a>, or congenital disorders such as <a href="/wiki/Congenital_adrenal_hyperplasia" title="Congenital adrenal hyperplasia">congenital adrenal hyperplasia</a>, <a href="/wiki/Adrenoleukodystrophy" title="Adrenoleukodystrophy">adrenoleukodystrophy</a>, <a href="/wiki/Familial_glucocorticoid_deficiency" class="mw-redirect" title="Familial glucocorticoid deficiency">familial glucocorticoid deficiency</a>, <a href="/wiki/Combined_pituitary_hormone_deficiency" class="mw-redirect" title="Combined pituitary hormone deficiency">combined pituitary hormone deficiency</a>, and <a href="/wiki/Proopiomelanocortin" title="Proopiomelanocortin">POMC</a> mutation. Adrenal insufficiency can also be caused by pituitary or <a href="/wiki/Adrenal_gland" title="Adrenal gland">adrenal gland</a> surgeries. Infections such as <a href="/wiki/Tuberculosis" title="Tuberculosis">tuberculosis</a>, <a href="/wiki/Histoplasmosis" title="Histoplasmosis">histoplasmosis</a>, <a href="/wiki/HIV" title="HIV">HIV</a>, and <a href="/wiki/Cytomegalovirus" title="Cytomegalovirus">CMV</a> can also cause adrenal insufficiency. Infiltrative disorders like <a href="/wiki/Sarcoidosis" title="Sarcoidosis">sarcoidosis</a>, <a href="/wiki/Amyloidosis" title="Amyloidosis">amyloidosis</a>, and <a href="/wiki/Haemochromatosis" class="mw-redirect" title="Haemochromatosis">haemochromatosis</a> have also been known to cause adrenal insufficiency. <a href="/wiki/Hemorrhages" class="mw-redirect" title="Hemorrhages">Hemorrhages</a> in the pituitary and adrenal glands, <a href="/wiki/Waterhouse%E2%80%93Friderichsen_syndrome" title="Waterhouse–Friderichsen syndrome">Waterhouse–Friderichsen syndrome</a>, <a href="/wiki/Vasculitis" title="Vasculitis">vasculitis</a>, <a href="/wiki/Pituitary_apoplexy" title="Pituitary apoplexy">pituitary apoplexy</a>, and <a href="/wiki/Sheehan%27s_syndrome" title="Sheehan's syndrome">Sheehan's syndrome</a> are vascular disorders that can cause adrenal insufficiency. Tumors on the pituitary gland or cancer <a href="/wiki/Metastasis" title="Metastasis">metastasis</a> can also cause adrenal insufficiency.<sup id="cite_ref-FOOTNOTEMartin-GraceDineenSherlockThompson202080_10-0" class="reference"><a href="#cite_note-FOOTNOTEMartin-GraceDineenSherlockThompson202080-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> </p><p>Exogenous <a href="/wiki/Steroid" title="Steroid">steroid</a> use is the most frequent cause of adrenal insufficiency, and those who use steroids also run the risk of experiencing an adrenal crisis. Adrenal crisis can be triggered by abrupt, and frequently unintentional, steroid withdrawal. The <a href="/wiki/Hypothalamic%E2%80%93pituitary%E2%80%93adrenal_axis" title="Hypothalamic–pituitary–adrenal axis">hypothalamic–pituitary–adrenal axis</a> is suppressed by the use of <a href="/wiki/Glucocorticoid" title="Glucocorticoid">glucocorticoids</a> in <a href="/wiki/Rectal_administration" title="Rectal administration">rectal</a>, spinal injections, <a href="/wiki/Intradermal_injection" title="Intradermal injection">injections into the dermis</a>, <a href="/wiki/Intraarticular_injection" class="mw-redirect" title="Intraarticular injection">injections into the joint</a>, <a href="/wiki/Nasal_spray" title="Nasal spray">nasal</a>, <a href="/wiki/Inhaled_corticosteroid" class="mw-redirect" title="Inhaled corticosteroid">inhaled</a>, or <a href="/wiki/Topical_glucocorticoids" title="Topical glucocorticoids">steroids applied to the skin</a>. At pharmacological dosages, <a href="/wiki/Medroxyprogesterone" title="Medroxyprogesterone">medroxyprogesterone</a> and <a href="/wiki/Megestrol" title="Megestrol">megestrol</a> also exhibit a notable <a href="/wiki/Glucocorticoid" title="Glucocorticoid">glucocorticoid</a> effect. This risk may increase if steroids are used concurrently with <a href="/wiki/Ritonavir" title="Ritonavir">ritonavir</a> which inhibits the liver's <a href="/wiki/CYP3A" title="CYP3A">CYP3A</a> enzyme that breaks down steroids.<sup id="cite_ref-FOOTNOTEPuarStikkelbroeckSmansZelissen2016339.e3-339.e4_11-0" class="reference"><a href="#cite_note-FOOTNOTEPuarStikkelbroeckSmansZelissen2016339.e3-339.e4-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup> There is a greater risk for adrenal suppression with longer durations, greater doses, and oral and intraarticular preparations of steroids. Nonetheless, no amount, time frame, or mode of administration can reliably predict adrenal insufficiency.<sup id="cite_ref-FOOTNOTEBroersenPereiraJørgensenDekkers20152176_12-0" class="reference"><a href="#cite_note-FOOTNOTEBroersenPereiraJørgensenDekkers20152176-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Risk_factors">Risk factors</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Adrenal_crisis&action=edit&section=3" title="Edit section: Risk factors"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Because of the lack of <a href="/wiki/Mineralocorticoid" title="Mineralocorticoid">mineralocorticoids</a>, increased risk of <a href="/wiki/Dehydration" title="Dehydration">dehydration</a> and <a href="/wiki/Hypovolemia" title="Hypovolemia">hypovolemia</a>, those with <a href="/wiki/Addison%27s_disease" title="Addison's disease">primary adrenal insufficiency</a> are at a higher risk of developing an adrenal crisis compared to those with <a href="/wiki/Secondary_adrenal_insufficiency" class="mw-redirect" title="Secondary adrenal insufficiency">secondary adrenal insufficiency</a>.<sup id="cite_ref-FOOTNOTEPuarStikkelbroeckSmansZelissen2016339.e3_13-0" class="reference"><a href="#cite_note-FOOTNOTEPuarStikkelbroeckSmansZelissen2016339.e3-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup> People who have both secondary adrenal insufficiency and <a href="/wiki/Diabetes_insipidus" title="Diabetes insipidus">diabetes insipidus</a> are even more likely to experience an adrenal crisis. This increased risk could be attributed to either the absence of <a href="/wiki/Vasopressin_receptor_1A" title="Vasopressin receptor 1A">V1-receptor</a>-mediated <a href="/wiki/Vasoconstriction" title="Vasoconstriction">vasoconstriction</a> in times of stress or the increased risk of <a href="/wiki/Dehydration" title="Dehydration">dehydration</a>.<sup id="cite_ref-FOOTNOTEPuarStikkelbroeckSmansZelissen2016339.e4_14-0" class="reference"><a href="#cite_note-FOOTNOTEPuarStikkelbroeckSmansZelissen2016339.e4-14"><span class="cite-bracket">[</span>14<span class="cite-bracket">]</span></a></sup> A higher risk of adrenal crisis has been linked to other medical conditions such as <a href="/wiki/Diabetes" title="Diabetes">diabetes</a> and asthma, though the exact mechanism is unknown.<sup id="cite_ref-FOOTNOTERushworthTorpyFalhammar2019854_15-0" class="reference"><a href="#cite_note-FOOTNOTERushworthTorpyFalhammar2019854-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> Those with adrenal insufficiency have a 50% risk of experiencing an adrenal crisis within their life,<sup id="cite_ref-FOOTNOTEPuarStikkelbroeckSmansZelissen2016339.e4_14-1" class="reference"><a href="#cite_note-FOOTNOTEPuarStikkelbroeckSmansZelissen2016339.e4-14"><span class="cite-bracket">[</span>14<span class="cite-bracket">]</span></a></sup> and those who have experienced an adrenal crisis in the past are more susceptible to re-developing adrenal crisis.<sup id="cite_ref-FOOTNOTEHahnerSpinnlerFassnachtBurger-Stritt2015414_16-0" class="reference"><a href="#cite_note-FOOTNOTEHahnerSpinnlerFassnachtBurger-Stritt2015414-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Triggers">Triggers</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Adrenal_crisis&action=edit&section=4" title="Edit section: Triggers"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>A known precipitating event can be found in over 90% of episodes of adrenal crisis.<sup id="cite_ref-FOOTNOTEPuarStikkelbroeckSmansZelissen2016339.e2_5-2" class="reference"><a href="#cite_note-FOOTNOTEPuarStikkelbroeckSmansZelissen2016339.e2-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> The most common cause of adrenal crisis is infections, specifically <a href="/wiki/Gastrointestinal_infection" class="mw-redirect" title="Gastrointestinal infection">gastrointestinal infections</a>.<sup id="cite_ref-FOOTNOTEPuarStikkelbroeckSmansZelissen2016339.e3_13-1" class="reference"><a href="#cite_note-FOOTNOTEPuarStikkelbroeckSmansZelissen2016339.e3-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-FOOTNOTEClaessenAndelaBiermaszPereira20214–5_17-0" class="reference"><a href="#cite_note-FOOTNOTEClaessenAndelaBiermaszPereira20214–5-17"><span class="cite-bracket">[</span>17<span class="cite-bracket">]</span></a></sup> Adrenal crises can also be caused by major surgery, dental operations, pregnancy/labour, extreme weather, serious injury/accidents, intense physical activity, <a href="/wiki/Vaccine" title="Vaccine">vaccines</a>, and emotional stress.<sup id="cite_ref-FOOTNOTEClaessenAndelaBiermaszPereira20215_18-0" class="reference"><a href="#cite_note-FOOTNOTEClaessenAndelaBiermaszPereira20215-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup> Those who have <a href="/wiki/Autoimmune_polyendocrine_syndrome_type_2" title="Autoimmune polyendocrine syndrome type 2">autoimmune polyendocrine syndrome type 2</a> might have both <a href="/wiki/Thyroid_disease" title="Thyroid disease">thyroid</a> and adrenal insufficiency. <a href="/wiki/Levothyroxine" title="Levothyroxine">Levothyroxine</a> can speed up the metabolism of <a href="/wiki/Cortisol" title="Cortisol">cortisol</a> and trigger an adrenal crisis.<sup id="cite_ref-FOOTNOTEPuarStikkelbroeckSmansZelissen2016339.e4_14-2" class="reference"><a href="#cite_note-FOOTNOTEPuarStikkelbroeckSmansZelissen2016339.e4-14"><span class="cite-bracket">[</span>14<span class="cite-bracket">]</span></a></sup> Several medications, including <a href="/wiki/Chemotherapy" title="Chemotherapy">chemotherapy</a> and <a href="/wiki/Immunotherapy" title="Immunotherapy">immunotherapy</a>, have been linked to an increased risk of adrenal crisis. <a href="/wiki/Immune_checkpoint_inhibitor" class="mw-redirect" title="Immune checkpoint inhibitor">Immune checkpoint inhibitors</a> are known to cause endocrine problems, including <a href="/wiki/Hypophysitis" title="Hypophysitis">hypophysitis</a> and <a href="/wiki/Adrenalitis" title="Adrenalitis">adrenalitis</a>, with subsequent adrenal insufficiency.<sup id="cite_ref-FOOTNOTEClaessenAndelaBiermaszPereira20215_18-1" class="reference"><a href="#cite_note-FOOTNOTEClaessenAndelaBiermaszPereira20215-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-FOOTNOTEBarroso-SousaBarryGarrido-CastroHodi2018178_19-0" class="reference"><a href="#cite_note-FOOTNOTEBarroso-SousaBarryGarrido-CastroHodi2018178-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Barbiturate" title="Barbiturate">Barbiturates</a> and adrenostatic medications may raise the risk of an adrenal crisis. <a href="/wiki/Cytochrome_P450_3A4" class="mw-redirect" title="Cytochrome P450 3A4">Cytochrome P450 3A4</a> inducers boost <a href="/wiki/Hydrocortisone" title="Hydrocortisone">hydrocortisone</a> metabolism, leading to a higher demand for hydrocortisone since hydrocortisone is being metabolized faster.<sup id="cite_ref-FOOTNOTEClaessenAndelaBiermaszPereira20215_18-2" class="reference"><a href="#cite_note-FOOTNOTEClaessenAndelaBiermaszPereira20215-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Mechanism">Mechanism</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Adrenal_crisis&action=edit&section=5" title="Edit section: Mechanism"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Glucocorticoid_receptor.png" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/f/f0/Glucocorticoid_receptor.png/220px-Glucocorticoid_receptor.png" decoding="async" width="220" height="147" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/f/f0/Glucocorticoid_receptor.png/330px-Glucocorticoid_receptor.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/f/f0/Glucocorticoid_receptor.png/440px-Glucocorticoid_receptor.png 2x" data-file-width="3374" data-file-height="2249" /></a><figcaption><b>Left:</b> <a href="/wiki/DNA-binding_domain" title="DNA-binding domain">DNA-binding domains</a> of a <a href="/wiki/Glucocorticoid_receptor" title="Glucocorticoid receptor">glucocorticoid receptor</a> <a href="/wiki/Protein_dimer" title="Protein dimer">homodimer</a> in the nucleus interacting with DNA. <b>Right:</b> Binding of synthetic glucocorticoid <a href="/wiki/Dexamethasone" title="Dexamethasone">dexamethasone</a> to <a href="/wiki/Ligand_binding_domain" class="mw-redirect" title="Ligand binding domain">ligand-binding</a> domain of receptor in <a href="/wiki/Cytoplasm" title="Cytoplasm">cytoplasm</a>.</figcaption></figure><p>An absolute or relative lack of <a href="/wiki/Cortisol" title="Cortisol">cortisol</a> causes adrenal crises since there is not enough tissue glucocorticoid activity to preserve <a href="/wiki/Homeostasis" title="Homeostasis">homeostasis</a>.<sup id="cite_ref-FOOTNOTERushworthTorpyFalhammar2019853_20-0" class="reference"><a href="#cite_note-FOOTNOTERushworthTorpyFalhammar2019853-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> Cortisol has a 70 to 120-minute <a href="/wiki/Half-life" title="Half-life">half-life</a>, meaning that cortisol levels fall within several hours of cortisol deprivation.<sup id="cite_ref-FOOTNOTEScherholzSchlesingerAndroulakis2019248_21-0" class="reference"><a href="#cite_note-FOOTNOTEScherholzSchlesingerAndroulakis2019248-21"><span class="cite-bracket">[</span>21<span class="cite-bracket">]</span></a></sup> Because cortisol modulates the transcription of <a href="/wiki/Gene" title="Gene">genes</a> containing a <a href="/wiki/Glucocorticoid" title="Glucocorticoid">glucocorticoid</a> response element, this effects many different genes. The physiological effects of low cortisol begin with the loss of the natural inhibitory function of glucocorticoids on inflammatory <a href="/wiki/Cytokine" title="Cytokine">cytokines</a>. This leads to sharp rises in cytokine concentrations, which can induce fever, <a href="/wiki/Lethargy" title="Lethargy">lethargy</a>, <a href="/wiki/Anorexia_(symptom)" title="Anorexia (symptom)">anorexia</a>, and pain. As a result, low cortisol causes changes in <a href="/wiki/White_blood_cell" title="White blood cell">immune-cell</a> levels, including <a href="/wiki/Lymphocytosis" title="Lymphocytosis">lymphocytosis</a>, <a href="/wiki/Eosinophilia" title="Eosinophilia">eosinophilia</a>, and <a href="/wiki/Neutropenia" title="Neutropenia">neutropenia</a>. Low levels of cortisol means that it loses its ability to work with <a href="/wiki/Catecholamine" title="Catecholamine">catecholamines</a> to reduce vascular reactivity, which causes <a href="/wiki/Vasodilation" title="Vasodilation">vasodilatation</a> and <a href="/wiki/Hypotension" title="Hypotension">hypotension</a>. Low cortisol has an adverse effect on the liver's metabolism, resulting in <a href="/wiki/Hypoglycemia" title="Hypoglycemia">hypoglycemia</a>, decreased <a href="/wiki/Gluconeogenesis" title="Gluconeogenesis">gluconeogenesis</a>, lower levels of <a href="/wiki/Fatty_acid" title="Fatty acid">free fatty acids</a> and <a href="/wiki/Amino_acid" title="Amino acid">amino acids</a> in circulation.<sup id="cite_ref-FOOTNOTERushworthTorpyFalhammar2019853_20-1" class="reference"><a href="#cite_note-FOOTNOTERushworthTorpyFalhammar2019853-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> </p><p>Loss of cortisol suppresses nuclear factor <a href="/wiki/%CE%9A-Bungarotoxin" title="Κ-Bungarotoxin">κB</a> (NF-κB) and <a href="/wiki/AP-1_transcription_factor" title="AP-1 transcription factor">activator protein 1</a> (AP-1), which allows genes that generate inflammatory proteins to be activated without restriction. This is because cortisol normally inhibits NF-κB's binding to the <a href="/wiki/Glucocorticoid_receptor" title="Glucocorticoid receptor">glucocorticoid receptor</a>. Additionally, through <a href="/wiki/Potassium" title="Potassium">potassium</a> retention and <a href="/wiki/Sodium" title="Sodium">sodium</a> and water loss, <a href="/wiki/Mineralocorticoid" title="Mineralocorticoid">mineralocorticoid</a> deficiency is likely to aggravate adrenal crises.<sup id="cite_ref-FOOTNOTERushworthTorpyFalhammar2019853_20-2" class="reference"><a href="#cite_note-FOOTNOTERushworthTorpyFalhammar2019853-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Diagnosis">Diagnosis</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Adrenal_crisis&action=edit&section=6" title="Edit section: Diagnosis"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure typeof="mw:File/Thumb"><a href="/wiki/File:Change_in_plasma_cortisol_cycle_over_24_hours.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/5/55/Change_in_plasma_cortisol_cycle_over_24_hours.jpg/248px-Change_in_plasma_cortisol_cycle_over_24_hours.jpg" decoding="async" width="248" height="176" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/5/55/Change_in_plasma_cortisol_cycle_over_24_hours.jpg/372px-Change_in_plasma_cortisol_cycle_over_24_hours.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/5/55/Change_in_plasma_cortisol_cycle_over_24_hours.jpg/496px-Change_in_plasma_cortisol_cycle_over_24_hours.jpg 2x" data-file-width="2494" data-file-height="1770" /></a><figcaption>Change in plasma <a href="/wiki/Cortisol" title="Cortisol">cortisol</a> cycle (mcg/dl) over 24 hours</figcaption></figure> <p>When a person with <a href="/wiki/Adrenal_insufficiency" title="Adrenal insufficiency">adrenal insufficiency</a> is known to be exhibiting symptoms of an adrenal crisis, treatment begins before diagnostic testing.<sup id="cite_ref-FOOTNOTEPuarStikkelbroeckSmansZelissen2016339.e4_14-3" class="reference"><a href="#cite_note-FOOTNOTEPuarStikkelbroeckSmansZelissen2016339.e4-14"><span class="cite-bracket">[</span>14<span class="cite-bracket">]</span></a></sup> When adrenal insufficiency is suspected a blood sample can be collected to test serum <a href="/wiki/Cortisol" title="Cortisol">cortisol</a> and <a href="/wiki/Adrenocorticotropic_hormone" title="Adrenocorticotropic hormone">ACTH</a> levels, while treatment begins during the wait for results. Once an acutely ill person has recovered, the diagnosis can be confirmed.<sup id="cite_ref-FOOTNOTEDineenThompsonSherlock20196_22-0" class="reference"><a href="#cite_note-FOOTNOTEDineenThompsonSherlock20196-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup> </p><p>Adrenal insufficiency can be diagnosed by testing <a href="/wiki/Renin" title="Renin">renin</a>, <a href="/wiki/Dehydroepiandrosterone_sulfate" title="Dehydroepiandrosterone sulfate">dehydroepiandrosterone sulfate</a>, <a href="/wiki/Aldosterone" title="Aldosterone">aldosterone</a>, serum cortisol, and ACTH levels.<sup id="cite_ref-FOOTNOTEPuarStikkelbroeckSmansZelissen2016339.e4_14-4" class="reference"><a href="#cite_note-FOOTNOTEPuarStikkelbroeckSmansZelissen2016339.e4-14"><span class="cite-bracket">[</span>14<span class="cite-bracket">]</span></a></sup> A high cortisol level of more than 13 to 15 mg/dL can rule out the diagnosis. A low cortisol level of less than 3 mg/dL, obtained in the early morning or during a stressful period, strongly suggests the possibility of adrenal insufficiency.<sup id="cite_ref-FOOTNOTETucciSokari2014475_23-0" class="reference"><a href="#cite_note-FOOTNOTETucciSokari2014475-23"><span class="cite-bracket">[</span>23<span class="cite-bracket">]</span></a></sup> In instances of <a href="/wiki/Addison%27s_disease" title="Addison's disease">primary adrenal insufficiency</a>, there is a correspondingly high ACTH level; in contrast, low or inappropriately normal ACTH correlates with tertiary or secondary adrenal insufficiency.<sup id="cite_ref-FOOTNOTEArltAllolio20031885–1886_24-0" class="reference"><a href="#cite_note-FOOTNOTEArltAllolio20031885–1886-24"><span class="cite-bracket">[</span>24<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Prevention">Prevention</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Adrenal_crisis&action=edit&section=7" title="Edit section: Prevention"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>A customized prescription as well as a plan for the administration of additional <a href="/wiki/Glucocorticoid" title="Glucocorticoid">glucocorticoids</a> for physiological stress are important preventative measures. If oral glucocorticoids are not an option, parenteral <a href="/wiki/Hydrocortisone" title="Hydrocortisone">hydrocortisone</a> can be used, preferably at home. Devices like <a href="/wiki/MedicAlert" title="MedicAlert">MedicAlert</a> bracelets and necklaces can alert caregivers to the possibility of adrenal crisis in those who are unable to communicate verbally.<sup id="cite_ref-FOOTNOTERushworthTorpyFalhammar2019858_25-0" class="reference"><a href="#cite_note-FOOTNOTERushworthTorpyFalhammar2019858-25"><span class="cite-bracket">[</span>25<span class="cite-bracket">]</span></a></sup> </p> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Hydrocortisone_100mg_vial_white_background.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/8/85/Hydrocortisone_100mg_vial_white_background.jpg/220px-Hydrocortisone_100mg_vial_white_background.jpg" decoding="async" width="220" height="343" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/8/85/Hydrocortisone_100mg_vial_white_background.jpg/330px-Hydrocortisone_100mg_vial_white_background.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/8/85/Hydrocortisone_100mg_vial_white_background.jpg/440px-Hydrocortisone_100mg_vial_white_background.jpg 2x" data-file-width="1032" data-file-height="1611" /></a><figcaption><a href="/wiki/Hydrocortisone" title="Hydrocortisone">Hydrocortisone</a> 100mg vial</figcaption></figure> <p>Although the exact dosage has been debated, it is generally agreed upon that anyone with proven adrenal insufficiency receives glucocorticoid replacement during stressful times.<sup id="cite_ref-FOOTNOTEPuarStikkelbroeckSmansZelissen2016339.e5_3-1" class="reference"><a href="#cite_note-FOOTNOTEPuarStikkelbroeckSmansZelissen2016339.e5-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> The recommended amounts of glucocorticoid replacement are dependent on the anticipated stress, and the current guidelines depend on expert opinion.<sup id="cite_ref-FOOTNOTESimpsonTomlinsonWassDean2020374_26-0" class="reference"><a href="#cite_note-FOOTNOTESimpsonTomlinsonWassDean2020374-26"><span class="cite-bracket">[</span>26<span class="cite-bracket">]</span></a></sup> Though there may be variations in specific regimens, most agree that stress doses for simple surgery is quickly tapered and does not last longer than three days. This is because unneeded steroid excess can lead to infections, poor wound healing, and <a href="/wiki/Hyperglycemia" title="Hyperglycemia">hyperglycemia</a>.<sup id="cite_ref-FOOTNOTEPuarStikkelbroeckSmansZelissen2016339.e5_3-2" class="reference"><a href="#cite_note-FOOTNOTEPuarStikkelbroeckSmansZelissen2016339.e5-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> </p><p>In those who are unable to tolerate oral medication or do not respond to stress doses, a low threshold to initiate parenteral hydrocortisone management can be used to guarantee adequate systemic absorption, since <a href="/wiki/Gastroenteritis" title="Gastroenteritis">gastroenteritis</a> frequently precedes an adrenal crisis<sup id="cite_ref-FOOTNOTEHahnerSpinnlerFassnachtBurger-Stritt2015414_16-1" class="reference"><a href="#cite_note-FOOTNOTEHahnerSpinnlerFassnachtBurger-Stritt2015414-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup> and stress dose glucocorticoids may not always avoid an adrenal crisis.<sup id="cite_ref-FOOTNOTEPuarStikkelbroeckSmansZelissen2016339.e5_3-3" class="reference"><a href="#cite_note-FOOTNOTEPuarStikkelbroeckSmansZelissen2016339.e5-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> </p><p>Those experiencing vomiting, chronic <a href="/wiki/Diarrhea" title="Diarrhea">diarrhea</a>, or an imminent adrenal crisis receive <a href="/wiki/Intramuscular_injection" title="Intramuscular injection">intramuscular</a> hydrocortisone. Individuals must be prepared to administer it themselves because they can rapidly deteriorate.<sup id="cite_ref-FOOTNOTESimpsonTomlinsonWassDean2020376_27-0" class="reference"><a href="#cite_note-FOOTNOTESimpsonTomlinsonWassDean2020376-27"><span class="cite-bracket">[</span>27<span class="cite-bracket">]</span></a></sup> Those with adrenal insufficiency may own a hydrocortisone ampoule,<sup id="cite_ref-FOOTNOTERepping-WutsStikkelbroeckNoordzijKerstens201320_28-0" class="reference"><a href="#cite_note-FOOTNOTERepping-WutsStikkelbroeckNoordzijKerstens201320-28"><span class="cite-bracket">[</span>28<span class="cite-bracket">]</span></a></sup> but not all have practiced the injection, and most will depend on medical professionals to give it to them in the event of an adrenal crisis episode. Individuals may experience significant physical as well as <a href="/wiki/Cognitive_impairment" title="Cognitive impairment">cognitive impairment</a> during their illness, which may impair their capacity to make wise decisions or administer medicine.<sup id="cite_ref-FOOTNOTEPuarStikkelbroeckSmansZelissen2016339.e5_3-4" class="reference"><a href="#cite_note-FOOTNOTEPuarStikkelbroeckSmansZelissen2016339.e5-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> Therefore, everyone with adrenal insufficiency can receive training on intramuscular hydrocortisone use and education on how to recognize an adrenal crisis, as well as assistance from a close family member or friend.<sup id="cite_ref-FOOTNOTESimpsonTomlinsonWassDean2020376_27-1" class="reference"><a href="#cite_note-FOOTNOTESimpsonTomlinsonWassDean2020376-27"><span class="cite-bracket">[</span>27<span class="cite-bracket">]</span></a></sup> </p><p>In case an individual suffering from <a href="/wiki/Adrenal_insufficiency" title="Adrenal insufficiency">adrenal insufficiency</a> loses consciousness, they must receive the necessary medical attention. Reminding those with adrenal insufficiency to always wear or keep a <a href="/wiki/MedicAlert" title="MedicAlert">MedicAlert</a> bracelet or just an emergency card is important. A survey of 46 people with adrenal insufficiency revealed that some medical professionals are reluctant to medicate the condition even when it is brought to their attention.<sup id="cite_ref-FOOTNOTEPuarStikkelbroeckSmansZelissen2016339.e5-339.e6_29-0" class="reference"><a href="#cite_note-FOOTNOTEPuarStikkelbroeckSmansZelissen2016339.e5-339.e6-29"><span class="cite-bracket">[</span>29<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-FOOTNOTEHahnerHemmelmannQuinklerBeuschlein2015497,501_30-0" class="reference"><a href="#cite_note-FOOTNOTEHahnerHemmelmannQuinklerBeuschlein2015497,501-30"><span class="cite-bracket">[</span>30<span class="cite-bracket">]</span></a></sup> Only 54% of those with adrenal insufficiency got glucocorticoid administration within 30 minutes of arrival, even though 86% of those with adrenal insufficiency were promptly attended to by a medical professional within forty-five minutes of a distress call.<sup id="cite_ref-FOOTNOTEHahnerHemmelmannQuinklerBeuschlein2015499–500_31-0" class="reference"><a href="#cite_note-FOOTNOTEHahnerHemmelmannQuinklerBeuschlein2015499–500-31"><span class="cite-bracket">[</span>31<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Treatment">Treatment</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Adrenal_crisis&action=edit&section=8" title="Edit section: Treatment"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The two foundations of treatment for adrenal crisis are steroid replacement and <a href="/wiki/Fluid_replacement" title="Fluid replacement">fluid resuscitation</a>.<sup id="cite_ref-FOOTNOTEPuarStikkelbroeckSmansZelissen2016339.e5_3-5" class="reference"><a href="#cite_note-FOOTNOTEPuarStikkelbroeckSmansZelissen2016339.e5-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> When adrenal crisis treatment is started as soon as possible, it can be effective in preventing irreversible effects from prolonged <a href="/wiki/Hypotension" title="Hypotension">hypotension</a>.<sup id="cite_ref-FOOTNOTERushworthTorpyFalhammar2019856_32-0" class="reference"><a href="#cite_note-FOOTNOTERushworthTorpyFalhammar2019856-32"><span class="cite-bracket">[</span>32<span class="cite-bracket">]</span></a></sup> Treatment should not be postponed while doing diagnostic tests. If there is reason to suspect something, a blood sample could be taken right away for <a href="/wiki/Adrenocorticotropic_hormone" title="Adrenocorticotropic hormone">ACTH</a> and serum <a href="/wiki/Cortisol" title="Cortisol">cortisol</a> testing; however, treatment needs to begin right away, regardless of the results of the assay. Once someone has recovered clinically, it is safe to confirm the diagnosis in an acutely ill person.<sup id="cite_ref-FOOTNOTEDineenThompsonSherlock20196_22-1" class="reference"><a href="#cite_note-FOOTNOTEDineenThompsonSherlock20196-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup> </p><p>In cases of emergency, parenteral <a href="/wiki/Hydrocortisone" title="Hydrocortisone">hydrocortisone</a> can be given as soon as possible by <a href="/wiki/Intramuscular_injection" title="Intramuscular injection">intramuscular</a> (IM) injection while IV access is being established, or as a <a href="/wiki/Bolus_(medicine)" title="Bolus (medicine)">bolus</a> injection of 100 mg of intravenous (IV) hydrocortisone. After this bolus, 200 mg of hydrocortisone should be administered every 24 hours, either continuously by IV infusion or, if that is not possible, in doses of 50 mg of hydrocortisone per IV/IM injection every 6 hours.<sup id="cite_ref-FOOTNOTEBornsteinAllolioArltBarthel2016367_33-0" class="reference"><a href="#cite_note-FOOTNOTEBornsteinAllolioArltBarthel2016367-33"><span class="cite-bracket">[</span>33<span class="cite-bracket">]</span></a></sup> </p><p><a href="/wiki/Hypovolemia" title="Hypovolemia">Hypovolemia</a> and <a href="/wiki/Hyponatremia" title="Hyponatremia">hyponatremia</a> can be corrected with intravenous fluid resuscitation using isotonic <a href="/wiki/Sodium_chloride" title="Sodium chloride">sodium chloride</a> 0.9%;<sup id="cite_ref-FOOTNOTEHusebyeAllolioArltBadenhoop2014106_34-0" class="reference"><a href="#cite_note-FOOTNOTEHusebyeAllolioArltBadenhoop2014106-34"><span class="cite-bracket">[</span>34<span class="cite-bracket">]</span></a></sup> the <a href="/wiki/Hypoglycemia" title="Hypoglycemia">hypoglycemia</a> may also need to be corrected with intravenous <a href="/wiki/Dextrose" class="mw-redirect" title="Dextrose">dextrose</a>.<sup id="cite_ref-FOOTNOTEHusebyeAllolioArltBadenhoop2014113_35-0" class="reference"><a href="#cite_note-FOOTNOTEHusebyeAllolioArltBadenhoop2014113-35"><span class="cite-bracket">[</span>35<span class="cite-bracket">]</span></a></sup> Over the course of the first hour, a liter of <a href="/wiki/Saline_(medicine)" title="Saline (medicine)">saline</a> 0.9% must be administered.<sup id="cite_ref-FOOTNOTEHusebyeAllolioArltBadenhoop2014112_36-0" class="reference"><a href="#cite_note-FOOTNOTEHusebyeAllolioArltBadenhoop2014112-36"><span class="cite-bracket">[</span>36<span class="cite-bracket">]</span></a></sup> Subsequent replacement fluids should be determined by measuring the serum <a href="/wiki/Electrolyte" title="Electrolyte">electrolytes</a> and conducting frequent <a href="/wiki/Hemodynamics" title="Hemodynamics">hemodynamic</a> monitoring.<sup id="cite_ref-FOOTNOTEHusebyeAllolioArltBadenhoop2014113_35-1" class="reference"><a href="#cite_note-FOOTNOTEHusebyeAllolioArltBadenhoop2014113-35"><span class="cite-bracket">[</span>35<span class="cite-bracket">]</span></a></sup> In cases of <a href="/wiki/Secondary_adrenal_insufficiency" class="mw-redirect" title="Secondary adrenal insufficiency">secondary adrenal insufficiency</a>, <a href="/wiki/Cortisol" title="Cortisol">cortisol</a> replacement can cause water <a href="/wiki/Diuresis" title="Diuresis">diuresis</a> and suppress <a href="/wiki/Vasopressin" title="Vasopressin">antidiuretic hormone</a>. When combined with <a href="/wiki/Sodium" title="Sodium">sodium</a> replacement, these effects can quickly correct hyponatremia as well as <a href="/wiki/Osmotic_demyelination_syndrome" class="mw-redirect" title="Osmotic demyelination syndrome">osmotic demyelination syndrome</a>. As a result, care must be taken to adjust <a href="/wiki/Sodium" title="Sodium">sodium</a> by less than 10 <a href="/wiki/MEq" class="mw-redirect" title="MEq">mEq</a> during the first 24 hours.<sup id="cite_ref-FOOTNOTEPuarStikkelbroeckSmansZelissen2016339.e5_3-6" class="reference"><a href="#cite_note-FOOTNOTEPuarStikkelbroeckSmansZelissen2016339.e5-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> </p><p>It is widely acknowledged that extra <a href="/wiki/Mineralocorticoid" title="Mineralocorticoid">mineralocorticoid</a> treatment is not necessary at hydrocortisone dosages greater than 50 mg/day because there is adequate action within the <a href="/wiki/Mineralocorticoid_receptor" title="Mineralocorticoid receptor">mineralocorticoid receptor</a>.<sup id="cite_ref-FOOTNOTEPuarStikkelbroeckSmansZelissen2016339.e5_3-7" class="reference"><a href="#cite_note-FOOTNOTEPuarStikkelbroeckSmansZelissen2016339.e5-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> In those who have <a href="/wiki/Addison%27s_disease" title="Addison's disease">primary adrenal insufficiency</a>, <a href="/wiki/Fludrocortisone" title="Fludrocortisone">fludrocortisone</a> needs to be started with subsequent dose tapering; for most people, a daily dose of 50–200 mcg is adequate.<sup id="cite_ref-FOOTNOTEHusebyeAllolioArltBadenhoop2014110_37-0" class="reference"><a href="#cite_note-FOOTNOTEHusebyeAllolioArltBadenhoop2014110-37"><span class="cite-bracket">[</span>37<span class="cite-bracket">]</span></a></sup> Those with <a href="/wiki/Lymphocytic_hypophysitis" class="mw-redirect" title="Lymphocytic hypophysitis">lymphocytic hypophysitis</a> can experience both <a href="/wiki/Adrenal_insufficiency" title="Adrenal insufficiency">adrenal insufficiency</a> as well as <a href="/wiki/Diabetes_insipidus" title="Diabetes insipidus">diabetes insipidus</a>. Whether or not a someone is receiving treatment for diabetes insipidus, fluid administration should be done carefully because too much fluid can lead to hypernatremia and too little water can cause hyponatremia. Hyponatremia is typically maintained with careful synchronization of urine output and a normal saline infusion.<sup id="cite_ref-FOOTNOTERushworthTorpyFalhammar2019856_32-1" class="reference"><a href="#cite_note-FOOTNOTERushworthTorpyFalhammar2019856-32"><span class="cite-bracket">[</span>32<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Outlook">Outlook</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Adrenal_crisis&action=edit&section=9" title="Edit section: Outlook"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>People with adrenal insufficiency are more likely to die from an adrenal crisis than other causes of death; the death rate from adrenal crises can amount to 6%.<sup id="cite_ref-FOOTNOTEHahnerSpinnlerFassnachtBurger-Stritt2015407_4-1" class="reference"><a href="#cite_note-FOOTNOTEHahnerSpinnlerFassnachtBurger-Stritt2015407-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> While symptoms may have gone unnoticed prior to the fatal episode, fatal adrenal crises have happened in those who had never been diagnosed with hypoadrenalism.<sup id="cite_ref-FOOTNOTESævikÅkermanGrønningNermoen2018191,_196_38-0" class="reference"><a href="#cite_note-FOOTNOTESævikÅkermanGrønningNermoen2018191,_196-38"><span class="cite-bracket">[</span>38<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Epidemiology">Epidemiology</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Adrenal_crisis&action=edit&section=10" title="Edit section: Epidemiology"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>An adrenal crisis occurs in roughly 6–8% of those with <a href="/wiki/Adrenal_insufficiency" title="Adrenal insufficiency">adrenal insufficiency</a> annually.<sup id="cite_ref-FOOTNOTERushworthTorpyFalhammar2017337_39-0" class="reference"><a href="#cite_note-FOOTNOTERushworthTorpyFalhammar2017337-39"><span class="cite-bracket">[</span>39<span class="cite-bracket">]</span></a></sup> Those with <a href="/wiki/Addison%27s_disease" title="Addison's disease">primary hypoadrenalism</a> experience adrenal crises somewhat more frequently compared to those with <a href="/wiki/Secondary_adrenal_insufficiency" class="mw-redirect" title="Secondary adrenal insufficiency">secondary adrenal insufficiency</a>. This is likely due to the fact that those with primary hypoadrenalism lack <a href="/wiki/Mineralocorticoid" title="Mineralocorticoid">mineralocorticoid</a> secretion and some with secondary adrenal insufficiency retain some <a href="/wiki/Cortisol" title="Cortisol">cortisol</a> secretion.<sup id="cite_ref-FOOTNOTERushworthTorpyFalhammar2019854_15-1" class="reference"><a href="#cite_note-FOOTNOTERushworthTorpyFalhammar2019854-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> Despite varying degrees of consequent adrenal suppression, those with <a href="/wiki/Adrenal_insufficiency" title="Adrenal insufficiency">hypoadrenalism</a> from long-term <a href="/wiki/Glucocorticoid" title="Glucocorticoid">glucocorticoid</a> therapy rarely experience adrenal crises.<sup id="cite_ref-FOOTNOTERushworthChrispTorpy20186_40-0" class="reference"><a href="#cite_note-FOOTNOTERushworthChrispTorpy20186-40"><span class="cite-bracket">[</span>40<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Special_populations">Special populations</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Adrenal_crisis&action=edit&section=11" title="Edit section: Special populations"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <div class="mw-heading mw-heading3"><h3 id="Geriatrics">Geriatrics</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Adrenal_crisis&action=edit&section=12" title="Edit section: Geriatrics"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure typeof="mw:File/Thumb"><a href="/wiki/File:Coronal_section_of_non-functioning_pituitary_adenoma.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/2/2c/Coronal_section_of_non-functioning_pituitary_adenoma.jpg/229px-Coronal_section_of_non-functioning_pituitary_adenoma.jpg" decoding="async" width="229" height="306" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/2/2c/Coronal_section_of_non-functioning_pituitary_adenoma.jpg/344px-Coronal_section_of_non-functioning_pituitary_adenoma.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/2/2c/Coronal_section_of_non-functioning_pituitary_adenoma.jpg/459px-Coronal_section_of_non-functioning_pituitary_adenoma.jpg 2x" data-file-width="3456" data-file-height="4608" /></a><figcaption><a href="/wiki/T1-weighted" class="mw-redirect" title="T1-weighted">T1-weighted</a> post contrast <a href="/wiki/Coronal_plane" title="Coronal plane">coronal</a> section of non-functioning <a href="/wiki/Pituitary_adenoma" title="Pituitary adenoma">pituitary adenoma</a>. The tumor is seen extending into the right <a href="/wiki/Cavernous_sinus" title="Cavernous sinus">cavernous sinus</a>.</figcaption></figure> <p>All age groups are susceptible to misclassification of an adrenal crisis diagnosis,<sup id="cite_ref-FOOTNOTERushworthTorpyFalhammar2017337_39-1" class="reference"><a href="#cite_note-FOOTNOTERushworthTorpyFalhammar2017337-39"><span class="cite-bracket">[</span>39<span class="cite-bracket">]</span></a></sup> but older people may be more vulnerable if relative <a href="/wiki/Hypotension" title="Hypotension">hypotension</a> is not evaluated, given the age-related rise in <a href="/wiki/Blood_pressure" title="Blood pressure">blood pressure</a>.<sup id="cite_ref-FOOTNOTEGoubarTorpyMcGrathRushworth20192199,_2201_41-0" class="reference"><a href="#cite_note-FOOTNOTEGoubarTorpyMcGrathRushworth20192199,_2201-41"><span class="cite-bracket">[</span>41<span class="cite-bracket">]</span></a></sup> It is possible to confuse <a href="/wiki/Hyponatremia" title="Hyponatremia">hyponatremia</a>, a common sign of <a href="/wiki/Adrenal_insufficiency" title="Adrenal insufficiency">adrenal insufficiency</a> or adrenal crisis, with the <a href="/wiki/Syndrome_of_inappropriate_antidiuretic_hormone_secretion" title="Syndrome of inappropriate antidiuretic hormone secretion">syndrome of inappropriate antidiuretic hormone secretion</a>, which is frequently brought on by disease, drugs, or aging itself.<sup id="cite_ref-FOOTNOTERushworthTorpyFalhammar2020632_42-0" class="reference"><a href="#cite_note-FOOTNOTERushworthTorpyFalhammar2020632-42"><span class="cite-bracket">[</span>42<span class="cite-bracket">]</span></a></sup> </p><p>The treatment of <a href="/wiki/Pituitary_adenoma" title="Pituitary adenoma">pituitary tumors</a> and the widespread use of <a href="/wiki/Opioid" title="Opioid">opioids</a> for pain, as well as exogenous <a href="/wiki/Glucocorticoid" title="Glucocorticoid">glucocorticoid</a> therapy for the numerous conditions that become more common in people over 60, are the main causes of a new diagnosis of adrenal insufficiency in older adults.<sup id="cite_ref-FOOTNOTERushworthTorpyFalhammar2020630_43-0" class="reference"><a href="#cite_note-FOOTNOTERushworthTorpyFalhammar2020630-43"><span class="cite-bracket">[</span>43<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-FOOTNOTERushworthChrispTorpy20184_44-0" class="reference"><a href="#cite_note-FOOTNOTERushworthChrispTorpy20184-44"><span class="cite-bracket">[</span>44<span class="cite-bracket">]</span></a></sup> Adrenal crisis is more likely to occur in older people.<sup id="cite_ref-FOOTNOTEIwasakuShinzawaTanakaKimachi20172,_4,_8_45-0" class="reference"><a href="#cite_note-FOOTNOTEIwasakuShinzawaTanakaKimachi20172,_4,_8-45"><span class="cite-bracket">[</span>45<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Urinary_tract_infection" title="Urinary tract infection">Urinary tract infections</a>, particularly in older women, are often linked to an adrenal crisis, as is <a href="/wiki/Pneumonia" title="Pneumonia">pneumonia</a> as well as a flare-up of <a href="/wiki/COPD" class="mw-redirect" title="COPD">COPD</a>. <a href="/wiki/Cellulitis" title="Cellulitis">Cellulitis</a> is linked to adrenal crises within this age range and may be more prevalent in those with fragile skin who have been exposed to higher doses of <a href="/wiki/Glucocorticoid" title="Glucocorticoid">glucocorticoids</a>. Older adults, especially those who have primary adrenal insufficiency, frequently experience falls and <a href="/wiki/Fractures,_bone" class="mw-redirect" title="Fractures, bone">fractures</a>, which may be linked to <a href="/wiki/Orthostatic_hypotension" title="Orthostatic hypotension">postural hypotension</a>.<sup id="cite_ref-FOOTNOTERushworthTorpyFalhammar2020633_46-0" class="reference"><a href="#cite_note-FOOTNOTERushworthTorpyFalhammar2020633-46"><span class="cite-bracket">[</span>46<span class="cite-bracket">]</span></a></sup> </p><p>Older people have a higher mortality rate from adrenal crisis, at least in part due to the existence of <a href="/wiki/Comorbidity" title="Comorbidity">comorbidities</a> that make treatment more difficult.<sup id="cite_ref-FOOTNOTEQuinklerEkmanZhangIsidori201832_47-0" class="reference"><a href="#cite_note-FOOTNOTEQuinklerEkmanZhangIsidori201832-47"><span class="cite-bracket">[</span>47<span class="cite-bracket">]</span></a></sup> While studies on the prevalence of adrenal crisis in older adults are limited, one population-based study into hospital admissions for adrenal crisis found that the incidence increased with age in older individuals, going from 24.3 (60–69 years) to 35.2 (70–79 years) and 45.8 (80+ years) per million per year. This is significantly higher compared to the general adult admission rate, which is 15.0 per million annually in the same population.<sup id="cite_ref-FOOTNOTERushworthTorpy20142,_3_48-0" class="reference"><a href="#cite_note-FOOTNOTERushworthTorpy20142,_3-48"><span class="cite-bracket">[</span>48<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Pregnancy">Pregnancy</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Adrenal_crisis&action=edit&section=13" title="Edit section: Pregnancy"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Most cases of adrenal insufficiency are identified before conception. Because the symptoms of <a href="/wiki/Hyperemesis_gravidarum" title="Hyperemesis gravidarum">hyperemesis gravidarum</a> (<a href="/wiki/Fatigue" title="Fatigue">fatigue</a>, vomiting, <a href="/wiki/Nausea" title="Nausea">nausea</a>, and mild <a href="/wiki/Hypotension" title="Hypotension">hypotension</a>) and normal pregnancy (nausea and vomiting) overlap, there is usually little clinical indication of adrenal insufficiency during pregnancy.<sup id="cite_ref-FOOTNOTEManoharanSinhaSibtain20205_49-0" class="reference"><a href="#cite_note-FOOTNOTEManoharanSinhaSibtain20205-49"><span class="cite-bracket">[</span>49<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-FOOTNOTEMacKinnonEubanksShayBelson2021e00278_50-0" class="reference"><a href="#cite_note-FOOTNOTEMacKinnonEubanksShayBelson2021e00278-50"><span class="cite-bracket">[</span>50<span class="cite-bracket">]</span></a></sup> Untreated adrenal crisis can cause severe morbidity in both the mother and the fetus, such as inadequate wound healing, infection, <a href="/wiki/Venous_thrombosis" title="Venous thrombosis">venous thromboembolism</a>, extended hospital stays, preterm birth, <a href="/wiki/Intrauterine_growth_restriction" title="Intrauterine growth restriction">fetal intrauterine growth restriction</a>, and an increased risk of <a href="/wiki/Caesarean_section" title="Caesarean section">cesarean delivery</a>. The occurrence of adrenal crisis during pregnancy is uncommon, even in people who have a documented history of adrenal insufficiency. In one study, pregnancy was identified as a trigger for adrenal crisis in 0.2% of the 423 participants. In a different study, only 1.1% of the 93 participants in the study who had a known insufficiency experienced an adrenal crisis during pregnancy.<sup id="cite_ref-FOOTNOTEMacKinnonEubanksShayBelson2021e00278_50-1" class="reference"><a href="#cite_note-FOOTNOTEMacKinnonEubanksShayBelson2021e00278-50"><span class="cite-bracket">[</span>50<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Children">Children</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Adrenal_crisis&action=edit&section=14" title="Edit section: Children"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure typeof="mw:File/Thumb"><a href="/wiki/File:CT_scan_shows_enlarged_adrenals_with_masses_consistent_with_congenital_adrenal_hyperplasia_due_to_21-hydroxylase_deficiency.png" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/c/c5/CT_scan_shows_enlarged_adrenals_with_masses_consistent_with_congenital_adrenal_hyperplasia_due_to_21-hydroxylase_deficiency.png/239px-CT_scan_shows_enlarged_adrenals_with_masses_consistent_with_congenital_adrenal_hyperplasia_due_to_21-hydroxylase_deficiency.png" decoding="async" width="239" height="217" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/c/c5/CT_scan_shows_enlarged_adrenals_with_masses_consistent_with_congenital_adrenal_hyperplasia_due_to_21-hydroxylase_deficiency.png/359px-CT_scan_shows_enlarged_adrenals_with_masses_consistent_with_congenital_adrenal_hyperplasia_due_to_21-hydroxylase_deficiency.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/c/c5/CT_scan_shows_enlarged_adrenals_with_masses_consistent_with_congenital_adrenal_hyperplasia_due_to_21-hydroxylase_deficiency.png/478px-CT_scan_shows_enlarged_adrenals_with_masses_consistent_with_congenital_adrenal_hyperplasia_due_to_21-hydroxylase_deficiency.png 2x" data-file-width="789" data-file-height="718" /></a><figcaption><a href="/wiki/Fluorodeoxyglucose_(18F)" title="Fluorodeoxyglucose (18F)">Fluorodeoxyglucose</a> <a href="/wiki/PET-CT" title="PET-CT">PET-CT</a> scan shows enlarged <a href="/wiki/Adrenal_gland" title="Adrenal gland">adrenals</a> with masses. Genetic and biochemical workup was consistent with <a href="/wiki/Congenital_adrenal_hyperplasia_due_to_21-hydroxylase_deficiency" title="Congenital adrenal hyperplasia due to 21-hydroxylase deficiency">congenital adrenal hyperplasia due to 21-hydroxylase deficiency</a>.</figcaption></figure> <p>A common finding in children experiencing an adrenal crisis is <a href="/wiki/Hypoglycemia" title="Hypoglycemia">hypoglycemia</a>. This can lead to <a href="/wiki/Seizure" title="Seizure">seizures</a>, which can result in permanent brain damage or even death.<sup id="cite_ref-FOOTNOTERushworthTorpyStratakisFalhammar2018343_51-0" class="reference"><a href="#cite_note-FOOTNOTERushworthTorpyStratakisFalhammar2018343-51"><span class="cite-bracket">[</span>51<span class="cite-bracket">]</span></a></sup> Due to issues with <a href="/wiki/Adrenal_gland" title="Adrenal gland">adrenomedullary</a> development as well as <a href="/wiki/Epinephrine" class="mw-redirect" title="Epinephrine">epinephrine</a> production, hypoglycemia may be more prominent in the context of acute adrenal insufficiency in congenital conditions, including <a href="/wiki/Congenital_adrenal_hyperplasia" title="Congenital adrenal hyperplasia">congenital adrenal hyperplasia</a>, compared to other forms of <a href="/wiki/Addison%27s_disease" title="Addison's disease">primary adrenal insufficiency</a>. The severity of the enzyme impairment is correlated with the degree of <a href="/wiki/Adrenal_gland" title="Adrenal gland">adrenomedullary</a> dysfunction.<sup id="cite_ref-FOOTNOTEWebbKrone2015459_52-0" class="reference"><a href="#cite_note-FOOTNOTEWebbKrone2015459-52"><span class="cite-bracket">[</span>52<span class="cite-bracket">]</span></a></sup> Severe <a href="/wiki/Hyperkalemia" title="Hyperkalemia">hyperkalemia</a> has also been linked to potentially fatal cardiac <a href="/wiki/Arrhythmia" title="Arrhythmia">arrhythmias</a>.<sup id="cite_ref-FOOTNOTERushworthTorpyStratakisFalhammar2018343_51-1" class="reference"><a href="#cite_note-FOOTNOTERushworthTorpyStratakisFalhammar2018343-51"><span class="cite-bracket">[</span>51<span class="cite-bracket">]</span></a></sup> </p><p>Studies have demonstrated that younger children with congenital adrenal hyperplasia experience adrenal crisis events more frequently than older children and adolescents.<sup id="cite_ref-FOOTNOTERushworthFalhammarMunnsMaguire20162,_4_53-0" class="reference"><a href="#cite_note-FOOTNOTERushworthFalhammarMunnsMaguire20162,_4-53"><span class="cite-bracket">[</span>53<span class="cite-bracket">]</span></a></sup> Psychosocial factors can alter the baseline adrenal crisis risk, especially as the transition from parental treatment oversight to self-management in adolescence.<sup id="cite_ref-FOOTNOTELassReinehr2015244–245_54-0" class="reference"><a href="#cite_note-FOOTNOTELassReinehr2015244–245-54"><span class="cite-bracket">[</span>54<span class="cite-bracket">]</span></a></sup> Management in this age group is further complicated by changes in cortisol <a href="/wiki/Pharmacokinetics" title="Pharmacokinetics">pharmacokinetics</a>, resulting in an increased clearance as well as volume without a change to the <a href="/wiki/Cortisol" title="Cortisol">cortisol</a> half-life that has been shown during the pubertal period.<sup id="cite_ref-FOOTNOTERushworthTorpyStratakisFalhammar2018345_55-0" class="reference"><a href="#cite_note-FOOTNOTERushworthTorpyStratakisFalhammar2018345-55"><span class="cite-bracket">[</span>55<span class="cite-bracket">]</span></a></sup> </p><p>There is still a significant morbidity and death associated with adrenal insufficiency in newborns and early children. It has been estimated that 5–10 episodes of adrenal crisis occur every 100 years in those with adrenal insufficiency; incidences may be higher in specific countries. Adrenal crisis among kids results in death in about 1/200 cases.<sup id="cite_ref-FOOTNOTERushworthTorpyStratakisFalhammar2018342_56-0" class="reference"><a href="#cite_note-FOOTNOTERushworthTorpyStratakisFalhammar2018342-56"><span class="cite-bracket">[</span>56<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="See_also">See also</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Adrenal_crisis&action=edit&section=15" title="Edit section: See also"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <ul><li><a href="/wiki/Stress_dose" title="Stress dose">Stress dose</a></li> <li><a href="/wiki/Adrenal_insufficiency" title="Adrenal insufficiency">Adrenal insufficiency</a></li></ul> <div class="mw-heading mw-heading2"><h2 id="References">References</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Adrenal_crisis&action=edit&section=16" title="Edit section: References"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <div class="mw-heading mw-heading3"><h3 id="Citations">Citations</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Adrenal_crisis&action=edit&section=17" title="Edit section: Citations"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1239543626">.mw-parser-output .reflist{margin-bottom:0.5em;list-style-type:decimal}@media screen{.mw-parser-output .reflist{font-size:90%}}.mw-parser-output .reflist .references{font-size:100%;margin-bottom:0;list-style-type:inherit}.mw-parser-output .reflist-columns-2{column-width:30em}.mw-parser-output .reflist-columns-3{column-width:25em}.mw-parser-output .reflist-columns{margin-top:0.3em}.mw-parser-output .reflist-columns ol{margin-top:0}.mw-parser-output .reflist-columns li{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .reflist-upper-alpha{list-style-type:upper-alpha}.mw-parser-output .reflist-upper-roman{list-style-type:upper-roman}.mw-parser-output .reflist-lower-alpha{list-style-type:lower-alpha}.mw-parser-output .reflist-lower-greek{list-style-type:lower-greek}.mw-parser-output .reflist-lower-roman{list-style-type:lower-roman}</style><div class="reflist"> <div class="mw-references-wrap mw-references-columns"><ol class="references"> <li id="cite_note-Monarch_Initiative_u386-1"><span class="mw-cite-backlink"><b><a href="#cite_ref-Monarch_Initiative_u386_1-0">^</a></b></span> <span class="reference-text"><style data-mw-deduplicate="TemplateStyles:r1238218222">.mw-parser-output cite.citation{font-style:inherit;word-wrap:break-word}.mw-parser-output .citation q{quotes:"\"""\"""'""'"}.mw-parser-output .citation:target{background-color:rgba(0,127,255,0.133)}.mw-parser-output .id-lock-free.id-lock-free a{background:url("//upload.wikimedia.org/wikipedia/commons/6/65/Lock-green.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-limited.id-lock-limited a,.mw-parser-output .id-lock-registration.id-lock-registration a{background:url("//upload.wikimedia.org/wikipedia/commons/d/d6/Lock-gray-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-subscription.id-lock-subscription a{background:url("//upload.wikimedia.org/wikipedia/commons/a/aa/Lock-red-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .cs1-ws-icon a{background:url("//upload.wikimedia.org/wikipedia/commons/4/4c/Wikisource-logo.svg")right 0.1em center/12px no-repeat}body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-free a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-limited a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-registration a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-subscription a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .cs1-ws-icon a{background-size:contain;padding:0 1em 0 0}.mw-parser-output .cs1-code{color:inherit;background:inherit;border:none;padding:inherit}.mw-parser-output .cs1-hidden-error{display:none;color:var(--color-error,#d33)}.mw-parser-output .cs1-visible-error{color:var(--color-error,#d33)}.mw-parser-output .cs1-maint{display:none;color:#085;margin-left:0.3em}.mw-parser-output .cs1-kern-left{padding-left:0.2em}.mw-parser-output .cs1-kern-right{padding-right:0.2em}.mw-parser-output .citation .mw-selflink{font-weight:inherit}@media screen{.mw-parser-output .cs1-format{font-size:95%}html.skin-theme-clientpref-night .mw-parser-output .cs1-maint{color:#18911f}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .cs1-maint{color:#18911f}}</style><cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://monarchinitiative.org/MONDO:0019801">"Monarch Initiative"</a>. <i>Monarch Initiative</i><span class="reference-accessdate">. Retrieved <span class="nowrap">December 8,</span> 2023</span>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Monarch+Initiative&rft.atitle=Monarch+Initiative&rft_id=https%3A%2F%2Fmonarchinitiative.org%2FMONDO%3A0019801&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAdrenal+crisis" class="Z3988"></span></span> </li> <li id="cite_note-Elshimy_2023-2"><span class="mw-cite-backlink">^ <a href="#cite_ref-Elshimy_2023_2-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-Elshimy_2023_2-1"><sup><i><b>b</b></i></sup></a> <a href="#cite_ref-Elshimy_2023_2-2"><sup><i><b>c</b></i></sup></a> <a href="#cite_ref-Elshimy_2023_2-3"><sup><i><b>d</b></i></sup></a> <a href="#cite_ref-Elshimy_2023_2-4"><sup><i><b>e</b></i></sup></a> <a href="#cite_ref-Elshimy_2023_2-5"><sup><i><b>f</b></i></sup></a> <a href="#cite_ref-Elshimy_2023_2-6"><sup><i><b>g</b></i></sup></a></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFElshimyChippaKaurJeong2023" class="citation book cs1">Elshimy G, Chippa V, Kaur J, Jeong JM (September 13, 2023). <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/books/NBK499968/">"Adrenal Crisis"</a>. <i>StatPearls</i>. Treasure Island (FL): StatPearls Publishing. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/29763143">29763143</a><span class="reference-accessdate">. Retrieved <span class="nowrap">December 8,</span> 2023</span>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Adrenal+Crisis&rft.btitle=StatPearls&rft.place=Treasure+Island+%28FL%29&rft.pub=StatPearls+Publishing&rft.date=2023-09-13&rft_id=info%3Apmid%2F29763143&rft.aulast=Elshimy&rft.aufirst=G&rft.au=Chippa%2C+V&rft.au=Kaur%2C+J&rft.au=Jeong%2C+JM&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fbooks%2FNBK499968%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAdrenal+crisis" class="Z3988"></span></span> </li> <li id="cite_note-FOOTNOTEPuarStikkelbroeckSmansZelissen2016339.e5-3"><span class="mw-cite-backlink">^ <a href="#cite_ref-FOOTNOTEPuarStikkelbroeckSmansZelissen2016339.e5_3-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-FOOTNOTEPuarStikkelbroeckSmansZelissen2016339.e5_3-1"><sup><i><b>b</b></i></sup></a> <a href="#cite_ref-FOOTNOTEPuarStikkelbroeckSmansZelissen2016339.e5_3-2"><sup><i><b>c</b></i></sup></a> <a href="#cite_ref-FOOTNOTEPuarStikkelbroeckSmansZelissen2016339.e5_3-3"><sup><i><b>d</b></i></sup></a> <a href="#cite_ref-FOOTNOTEPuarStikkelbroeckSmansZelissen2016339.e5_3-4"><sup><i><b>e</b></i></sup></a> <a href="#cite_ref-FOOTNOTEPuarStikkelbroeckSmansZelissen2016339.e5_3-5"><sup><i><b>f</b></i></sup></a> <a href="#cite_ref-FOOTNOTEPuarStikkelbroeckSmansZelissen2016339.e5_3-6"><sup><i><b>g</b></i></sup></a> <a href="#cite_ref-FOOTNOTEPuarStikkelbroeckSmansZelissen2016339.e5_3-7"><sup><i><b>h</b></i></sup></a></span> <span class="reference-text"><a href="#CITEREFPuarStikkelbroeckSmansZelissen2016">Puar et al. 2016</a>, p. 339.e5.</span> </li> <li id="cite_note-FOOTNOTEHahnerSpinnlerFassnachtBurger-Stritt2015407-4"><span class="mw-cite-backlink">^ <a href="#cite_ref-FOOTNOTEHahnerSpinnlerFassnachtBurger-Stritt2015407_4-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-FOOTNOTEHahnerSpinnlerFassnachtBurger-Stritt2015407_4-1"><sup><i><b>b</b></i></sup></a></span> <span class="reference-text"><a href="#CITEREFHahnerSpinnlerFassnachtBurger-Stritt2015">Hahner et al. 2015</a>, p. 407.</span> </li> <li id="cite_note-FOOTNOTEPuarStikkelbroeckSmansZelissen2016339.e2-5"><span class="mw-cite-backlink">^ <a href="#cite_ref-FOOTNOTEPuarStikkelbroeckSmansZelissen2016339.e2_5-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-FOOTNOTEPuarStikkelbroeckSmansZelissen2016339.e2_5-1"><sup><i><b>b</b></i></sup></a> <a href="#cite_ref-FOOTNOTEPuarStikkelbroeckSmansZelissen2016339.e2_5-2"><sup><i><b>c</b></i></sup></a></span> <span class="reference-text"><a href="#CITEREFPuarStikkelbroeckSmansZelissen2016">Puar et al. 2016</a>, p. 339.e2.</span> </li> <li id="cite_note-FOOTNOTETucciSokari2014474-6"><span class="mw-cite-backlink">^ <a href="#cite_ref-FOOTNOTETucciSokari2014474_6-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-FOOTNOTETucciSokari2014474_6-1"><sup><i><b>b</b></i></sup></a></span> <span class="reference-text"><a href="#CITEREFTucciSokari2014">Tucci & 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Krone, Nils (June 2015). <a rel="nofollow" class="external text" href="http://pure-oai.bham.ac.uk/ws/files/19590655/Webb_Krone_Current_novel_approaches_children_Best_Practice_Research_Clinical_Endocrinology_Metabolism_2015.pdf">"Current and novel approaches to children and young people with congenital adrenal hyperplasia and adrenal insufficiency"</a> <span class="cs1-format">(PDF)</span>. <i>Best Practice & Research Clinical Endocrinology & Metabolism</i>. <b>29</b> (3). <a href="/wiki/Elsevier" title="Elsevier">Elsevier</a>: 449–468. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1016%2Fj.beem.2015.04.002">10.1016/j.beem.2015.04.002</a>. <a href="/wiki/ISSN_(identifier)" class="mw-redirect" title="ISSN (identifier)">ISSN</a> <a rel="nofollow" class="external text" href="https://search.worldcat.org/issn/1521-690X">1521-690X</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/26051302">26051302</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Best+Practice+%26+Research+Clinical+Endocrinology+%26+Metabolism&rft.atitle=Current+and+novel+approaches+to+children+and+young+people+with+congenital+adrenal+hyperplasia+and+adrenal+insufficiency&rft.volume=29&rft.issue=3&rft.pages=449-468&rft.date=2015-06&rft.issn=1521-690X&rft_id=info%3Apmid%2F26051302&rft_id=info%3Adoi%2F10.1016%2Fj.beem.2015.04.002&rft.aulast=Webb&rft.aufirst=Emma+A.&rft.au=Krone%2C+Nils&rft_id=http%3A%2F%2Fpure-oai.bham.ac.uk%2Fws%2Ffiles%2F19590655%2FWebb_Krone_Current_novel_approaches_children_Best_Practice_Research_Clinical_Endocrinology_Metabolism_2015.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAdrenal+crisis" class="Z3988"></span></li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFRushworthFalhammarMunnsMaguire2016" class="citation journal cs1">Rushworth, R. Louise; Falhammar, Henrik; Munns, Craig F.; Maguire, Ann M.; Torpy, David J. (2016). <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4736605">"Hospital Admission Patterns in Children with CAH: Admission Rates and Adrenal Crises Decline with Age"</a>. <i><a href="/wiki/International_Journal_of_Endocrinology" class="mw-redirect" title="International Journal of Endocrinology">International Journal of Endocrinology</a></i>. <b>2016</b>. <a href="/wiki/Hindawi_(publisher)" title="Hindawi (publisher)">Hindawi</a>: 1–7. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://doi.org/10.1155%2F2016%2F5748264">10.1155/2016/5748264</a></span>. <a href="/wiki/ISSN_(identifier)" class="mw-redirect" title="ISSN (identifier)">ISSN</a> <a rel="nofollow" class="external text" href="https://search.worldcat.org/issn/1687-8337">1687-8337</a>. <a href="/wiki/PMC_(identifier)" class="mw-redirect" title="PMC (identifier)">PMC</a> <span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4736605">4736605</a></span>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/26880914">26880914</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=International+Journal+of+Endocrinology&rft.atitle=Hospital+Admission+Patterns+in+Children+with+CAH%3A+Admission+Rates+and+Adrenal+Crises+Decline+with+Age&rft.volume=2016&rft.pages=1-7&rft.date=2016&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4736605%23id-name%3DPMC&rft.issn=1687-8337&rft_id=info%3Apmid%2F26880914&rft_id=info%3Adoi%2F10.1155%2F2016%2F5748264&rft.aulast=Rushworth&rft.aufirst=R.+Louise&rft.au=Falhammar%2C+Henrik&rft.au=Munns%2C+Craig+F.&rft.au=Maguire%2C+Ann+M.&rft.au=Torpy%2C+David+J.&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4736605&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAdrenal+crisis" class="Z3988"></span></li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFLassReinehr2015" class="citation journal cs1">Lass, Nina; Reinehr, Thomas (2015). "Low Treatment Adherence in Pubertal Children Treated with Thyroxin or Growth Hormone". <i><a href="/wiki/Hormone_Research_in_Paediatrics" title="Hormone Research in Paediatrics">Hormone Research in Paediatrics</a></i>. <b>84</b> (4). <a href="/wiki/Karger_Publishers" title="Karger Publishers">Karger</a>: 240–247. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1159%2F000437305">10.1159/000437305</a>. <a href="/wiki/ISSN_(identifier)" class="mw-redirect" title="ISSN (identifier)">ISSN</a> <a rel="nofollow" class="external text" href="https://search.worldcat.org/issn/1663-2818">1663-2818</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/26279278">26279278</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Hormone+Research+in+Paediatrics&rft.atitle=Low+Treatment+Adherence+in+Pubertal+Children+Treated+with+Thyroxin+or+Growth+Hormone&rft.volume=84&rft.issue=4&rft.pages=240-247&rft.date=2015&rft.issn=1663-2818&rft_id=info%3Apmid%2F26279278&rft_id=info%3Adoi%2F10.1159%2F000437305&rft.aulast=Lass&rft.aufirst=Nina&rft.au=Reinehr%2C+Thomas&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAdrenal+crisis" class="Z3988"></span></li></ul> </div> <div class="mw-heading mw-heading2"><h2 id="Further_reading">Further reading</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Adrenal_crisis&action=edit&section=19" title="Edit section: Further reading"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1239549316"><div class="refbegin" style=""> <ul><li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation journal cs1">Lentz, Skyler; Collier, Kathryn C.; Willis, George; Long, Brit (August 2022). "Diagnosis and Management of Adrenal Insufficiency and Adrenal Crisis in the Emergency Department". <i><a href="/wiki/The_Journal_of_Emergency_Medicine" title="The Journal of Emergency Medicine">The Journal of Emergency Medicine</a></i>. <b>63</b> (2). <a href="/wiki/Elsevier" title="Elsevier">Elsevier</a>: 212–220. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1016%2Fj.jemermed.2022.06.005">10.1016/j.jemermed.2022.06.005</a>. <a href="/wiki/ISSN_(identifier)" class="mw-redirect" title="ISSN (identifier)">ISSN</a> <a rel="nofollow" class="external text" href="https://search.worldcat.org/issn/0736-4679">0736-4679</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/36038436">36038436</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+Emergency+Medicine&rft.atitle=Diagnosis+and+Management+of+Adrenal+Insufficiency+and+Adrenal+Crisis+in+the+Emergency+Department&rft.volume=63&rft.issue=2&rft.pages=212-220&rft.date=2022-08&rft.issn=0736-4679&rft_id=info%3Apmid%2F36038436&rft_id=info%3Adoi%2F10.1016%2Fj.jemermed.2022.06.005&rft.aulast=Lentz&rft.aufirst=Skyler&rft.au=Collier%2C+Kathryn+C.&rft.au=Willis%2C+George&rft.au=Long%2C+Brit&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAdrenal+crisis" class="Z3988"></span></li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation journal cs1">Rushworth, R. Louise; Chrisp, Georgina L.; Torpy, David J. (May 2018). "Glucocorticoid-Induced Adrenal Insufficiency: A Study of the Incidence in Hospital Patients and A Review of Peri-Operative Management". <i><a href="/wiki/Endocrine_Practice" title="Endocrine Practice">Endocrine Practice</a></i>. <b>24</b> (5). <a href="/wiki/Elsevier" title="Elsevier">Elsevier</a>: 437–445. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.4158%2FEP-2017-0117">10.4158/EP-2017-0117</a>. <a href="/wiki/ISSN_(identifier)" class="mw-redirect" title="ISSN (identifier)">ISSN</a> <a rel="nofollow" class="external text" href="https://search.worldcat.org/issn/1530-891X">1530-891X</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/29498915">29498915</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Endocrine+Practice&rft.atitle=Glucocorticoid-Induced+Adrenal+Insufficiency%3A+A+Study+of+the+Incidence+in+Hospital+Patients+and+A+Review+of+Peri-Operative+Management&rft.volume=24&rft.issue=5&rft.pages=437-445&rft.date=2018-05&rft.issn=1530-891X&rft_id=info%3Apmid%2F29498915&rft_id=info%3Adoi%2F10.4158%2FEP-2017-0117&rft.aulast=Rushworth&rft.aufirst=R.+Louise&rft.au=Chrisp%2C+Georgina+L.&rft.au=Torpy%2C+David+J.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAdrenal+crisis" class="Z3988"></span></li></ul> </div> <div class="mw-heading mw-heading2"><h2 id="External_links">External links</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Adrenal_crisis&action=edit&section=20" title="Edit section: External links"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <ul><li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://www.uclahealth.org/medical-services/surgery/endocrine-surgery/patient-resources/patient-education/endocrine-surgery-encyclopedia/acute-adrenal-crisis">"Acute Adrenal Crisis"</a>. <i><a href="/wiki/UCLA_Health" title="UCLA Health">UCLA Health</a></i>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=UCLA+Health&rft.atitle=Acute+Adrenal+Crisis&rft_id=https%3A%2F%2Fwww.uclahealth.org%2Fmedical-services%2Fsurgery%2Fendocrine-surgery%2Fpatient-resources%2Fpatient-education%2Fendocrine-surgery-encyclopedia%2Facute-adrenal-crisis&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAdrenal+crisis" class="Z3988"></span></li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://my.clevelandclinic.org/health/diseases/23948-adrenal-crisis">"Adrenal Crisis: Causes, Symptoms, Diagnosis & Treatment"</a>. <i><a href="/wiki/Cleveland_Clinic" title="Cleveland Clinic">Cleveland Clinic</a></i>. August 8, 2022.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Cleveland+Clinic&rft.atitle=Adrenal+Crisis%3A+Causes%2C+Symptoms%2C+Diagnosis+%26+Treatment&rft.date=2022-08-08&rft_id=https%3A%2F%2Fmy.clevelandclinic.org%2Fhealth%2Fdiseases%2F23948-adrenal-crisis&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAdrenal+crisis" class="Z3988"></span></li></ul> <div class="navbox-styles"><style data-mw-deduplicate="TemplateStyles:r1236075235">.mw-parser-output .navbox{box-sizing:border-box;border:1px solid #a2a9b1;width:100%;clear:both;font-size:88%;text-align:center;padding:1px;margin:1em auto 0}.mw-parser-output .navbox .navbox{margin-top:0}.mw-parser-output .navbox+.navbox,.mw-parser-output .navbox+.navbox-styles+.navbox{margin-top:-1px}.mw-parser-output .navbox-inner,.mw-parser-output .navbox-subgroup{width:100%}.mw-parser-output .navbox-group,.mw-parser-output .navbox-title,.mw-parser-output .navbox-abovebelow{padding:0.25em 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dd:first-child::before,.mw-parser-output .hlist li dt:first-child::before,.mw-parser-output .hlist li li:first-child::before{content:" (";font-weight:normal}.mw-parser-output .hlist dd dd:last-child::after,.mw-parser-output .hlist dd dt:last-child::after,.mw-parser-output .hlist dd li:last-child::after,.mw-parser-output .hlist dt dd:last-child::after,.mw-parser-output .hlist dt dt:last-child::after,.mw-parser-output .hlist dt li:last-child::after,.mw-parser-output .hlist li dd:last-child::after,.mw-parser-output .hlist li dt:last-child::after,.mw-parser-output .hlist li li:last-child::after{content:")";font-weight:normal}.mw-parser-output .hlist ol{counter-reset:listitem}.mw-parser-output .hlist ol>li{counter-increment:listitem}.mw-parser-output .hlist ol>li::before{content:" "counter(listitem)"\a0 "}.mw-parser-output .hlist dd ol>li:first-child::before,.mw-parser-output .hlist dt ol>li:first-child::before,.mw-parser-output .hlist li ol>li:first-child::before{content:" ("counter(listitem)"\a0 "}</style><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"></div><div role="navigation" class="navbox" aria-label="Navbox" style="width:100%; margin:0.5em 0 0.5em 0;;padding:3px"><table class="nowraplinks navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="row" class="navbox-group" style="width:1%;background: #EAECF0;color:black;">Classification</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"><div style="position:relative; float:right; font-size:0.8em;"><a href="https://www.wikidata.org/wiki/Q4057453" class="extiw" title="d:Q4057453">D</a></div><div class="hlist" style="text-align:left;"><ul><li><b><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/ICD-11" title="ICD-11">11</a></b>: <a rel="nofollow" class="external text" href="https://icd.who.int/browse/latest-release/mms/en#114442391">5A74.1</a></li><li><b><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/ICD-10" title="ICD-10">10</a></b>: <a rel="nofollow" class="external text" href="https://icd.who.int/browse10/2019/en#/E27.2">E27.2</a></li><li><b><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/List_of_ICD-9_codes" title="List of ICD-9 codes">9-CM</a></b>: <a rel="nofollow" class="external text" href="http://www.icd9data.com/getICD9Code.ashx?icd9=255.41">255.41</a></li><li><b><a href="/wiki/SNOMED_CT" title="SNOMED CT">SNOMED CT</a></b>: <a rel="nofollow" class="external text" href="http://snomed.info/id/766986002">766986002</a></li></ul></div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background: #EAECF0;color:black;">External resources</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"><div class="hlist" style="text-align:left;"><ul><li><b><a href="/wiki/MedlinePlus" title="MedlinePlus">MedlinePlus</a></b>: <a rel="nofollow" class="external text" href="https://www.nlm.nih.gov/medlineplus/ency/article/000357.htm">000357</a></li><li><b><a href="/wiki/EMedicine" title="EMedicine">eMedicine</a></b>: <a rel="nofollow" class="external text" href="https://emedicine.medscape.com/article/116716-overview">article/116716</a> <a rel="nofollow" class="external text" href="https://emedicine.medscape.com/article/765753-overview">article/765753</a></li><li><b><a href="/wiki/Patient_UK" title="Patient UK">Patient UK</a></b>: <a rel="nofollow" class="external text" href="https://patient.info/doctor/Adrenal">Crisis Adrenal crisis</a></li><li><b><a href="/wiki/Orphanet" title="Orphanet">Orphanet</a></b>: <a rel="nofollow" class="external text" href="https://www.orpha.net/consor/cgi-bin/OC_Exp.php?lng=en&Expert=95409">95409</a></li><li><b>Scholia</b>: <a class="external text" href="https://tools.wmflabs.org/scholia/topic/Q4057453">Q4057453</a></li></ul></div></div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox" aria-labelledby="Adrenal_gland_disorder" style="padding:3px"><table class="nowraplinks mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><style data-mw-deduplicate="TemplateStyles:r1239400231">.mw-parser-output .navbar{display:inline;font-size:88%;font-weight:normal}.mw-parser-output .navbar-collapse{float:left;text-align:left}.mw-parser-output .navbar-boxtext{word-spacing:0}.mw-parser-output .navbar ul{display:inline-block;white-space:nowrap;line-height:inherit}.mw-parser-output .navbar-brackets::before{margin-right:-0.125em;content:"[ "}.mw-parser-output .navbar-brackets::after{margin-left:-0.125em;content:" ]"}.mw-parser-output .navbar li{word-spacing:-0.125em}.mw-parser-output .navbar a>span,.mw-parser-output .navbar a>abbr{text-decoration:inherit}.mw-parser-output .navbar-mini abbr{font-variant:small-caps;border-bottom:none;text-decoration:none;cursor:inherit}.mw-parser-output .navbar-ct-full{font-size:114%;margin:0 7em}.mw-parser-output .navbar-ct-mini{font-size:114%;margin:0 4em}html.skin-theme-clientpref-night .mw-parser-output .navbar li a abbr{color:var(--color-base)!important}@media(prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .navbar li a abbr{color:var(--color-base)!important}}@media print{.mw-parser-output .navbar{display:none!important}}</style><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Adrenal_gland_disorder" title="Template:Adrenal gland disorder"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Adrenal_gland_disorder" title="Template talk:Adrenal gland disorder"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Adrenal_gland_disorder" title="Special:EditPage/Template:Adrenal gland disorder"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Adrenal_gland_disorder" style="font-size:114%;margin:0 4em"><a href="/wiki/Adrenal_gland_disorder" title="Adrenal gland disorder">Adrenal gland disorder</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Adrenocortical_hyperfunction" title="Adrenocortical hyperfunction">Hyperfunction</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Aldosterone" title="Aldosterone">Aldosterone</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Hyperaldosteronism" title="Hyperaldosteronism">Hyperaldosteronism</a></li> <li><a href="/wiki/Primary_aldosteronism" title="Primary aldosteronism">Primary aldosteronism</a> <ul><li><a href="/wiki/Conn_syndrome" class="mw-redirect" title="Conn syndrome">Conn syndrome</a></li> <li><a href="/wiki/Bartter_syndrome" title="Bartter syndrome">Bartter syndrome</a></li> <li><a href="/wiki/Glucocorticoid_remediable_aldosteronism" title="Glucocorticoid remediable aldosteronism">Glucocorticoid remediable aldosteronism</a></li></ul></li> <li><a href="/wiki/Apparent_mineralocorticoid_excess_syndrome" title="Apparent mineralocorticoid excess syndrome">AME</a></li> <li><a href="/wiki/Liddle%27s_syndrome" title="Liddle's syndrome">Liddle's syndrome</a></li> <li><a href="/wiki/Congenital_adrenal_hyperplasia_due_to_17_alpha-hydroxylase_deficiency" class="mw-redirect" title="Congenital adrenal hyperplasia due to 17 alpha-hydroxylase deficiency">17α CAH</a></li> <li><a href="/wiki/Pseudohypoaldosteronism" title="Pseudohypoaldosteronism">Pseudohypoaldosteronism</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Cortisol" title="Cortisol">Cortisol</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Cushing%27s_syndrome" title="Cushing's syndrome">Cushing's syndrome</a> <ul><li><a href="/wiki/Pseudo-Cushing%27s_syndrome" title="Pseudo-Cushing's syndrome">Pseudo-Cushing's syndrome</a></li></ul></li> <li><a href="/wiki/Steroid-induced_osteoporosis" title="Steroid-induced osteoporosis">Steroid-induced osteoporosis</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Sex_hormone" title="Sex hormone">Sex hormones</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Congenital_adrenal_hyperplasia_due_to_21-hydroxylase_deficiency" title="Congenital adrenal hyperplasia due to 21-hydroxylase deficiency">21α CAH</a></li> <li><a href="/wiki/Congenital_adrenal_hyperplasia_due_to_11%CE%B2-hydroxylase_deficiency" title="Congenital adrenal hyperplasia due to 11β-hydroxylase deficiency">11β CAH</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Hypofunction</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%">Aldosterone</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Hypoaldosteronism" title="Hypoaldosteronism">Hypoaldosteronism</a> <ul><li><a href="/wiki/Congenital_adrenal_hyperplasia_due_to_21-hydroxylase_deficiency" title="Congenital adrenal hyperplasia due to 21-hydroxylase deficiency">21α CAH</a></li> <li><a href="/wiki/Congenital_adrenal_hyperplasia_due_to_11%CE%B2-hydroxylase_deficiency" title="Congenital adrenal hyperplasia due to 11β-hydroxylase deficiency">11β CAH</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Cortisol</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Congenital_adrenal_hyperplasia" title="Congenital adrenal hyperplasia">CAH</a> <ul><li><a href="/wiki/Lipoid_congenital_adrenal_hyperplasia" title="Lipoid congenital adrenal hyperplasia">Lipoid</a></li> <li><a href="/wiki/Congenital_adrenal_hyperplasia_due_to_3_beta-hydroxysteroid_dehydrogenase_deficiency" class="mw-redirect" title="Congenital adrenal hyperplasia due to 3 beta-hydroxysteroid dehydrogenase deficiency">3β</a></li> <li><a href="/wiki/Congenital_adrenal_hyperplasia_due_to_11%CE%B2-hydroxylase_deficiency" title="Congenital adrenal hyperplasia due to 11β-hydroxylase deficiency">11β</a></li> <li><a href="/wiki/Congenital_adrenal_hyperplasia_due_to_17_alpha-hydroxylase_deficiency" class="mw-redirect" title="Congenital adrenal hyperplasia due to 17 alpha-hydroxylase deficiency">17α</a></li> <li><a href="/wiki/Congenital_adrenal_hyperplasia_due_to_21-hydroxylase_deficiency" title="Congenital adrenal hyperplasia due to 21-hydroxylase deficiency">21α</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Sex hormones</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Congenital_adrenal_hyperplasia_due_to_17_alpha-hydroxylase_deficiency" class="mw-redirect" title="Congenital adrenal hyperplasia due to 17 alpha-hydroxylase deficiency">17α CAH</a></li> <li><a href="/wiki/Inborn_errors_of_steroid_metabolism" title="Inborn errors of steroid metabolism">Inborn errors of steroid metabolism</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Adrenal_insufficiency" title="Adrenal insufficiency">Adrenal insufficiency</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a class="mw-selflink selflink">Adrenal crisis</a></li> <li><a href="/wiki/Adrenalitis" title="Adrenalitis">Adrenalitis</a> <ul><li><a href="/wiki/Xanthogranulomatous_inflammation" title="Xanthogranulomatous inflammation">Xanthogranulomatous</a></li></ul></li> <li><a href="/wiki/Addison%27s_disease" title="Addison's disease">Addison's disease</a></li> <li><a href="/wiki/Waterhouse%E2%80%93Friderichsen_syndrome" title="Waterhouse–Friderichsen syndrome">Waterhouse–Friderichsen syndrome</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox" aria-labelledby="Shock" style="padding:3px"><table class="nowraplinks hlist mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1239400231"><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Shock_types" title="Template:Shock types"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Shock_types" title="Template talk:Shock types"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Shock_types" title="Special:EditPage/Template:Shock types"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Shock" style="font-size:114%;margin:0 4em"><a href="/wiki/Shock_(circulatory)" title="Shock (circulatory)">Shock</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Distributive_shock" title="Distributive shock">Distributive</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Septic_shock" title="Septic shock">Septic shock</a></li> <li><a href="/wiki/Neurogenic_shock" title="Neurogenic shock">Neurogenic shock</a></li> <li><a href="/wiki/Anaphylactic_shock" class="mw-redirect" title="Anaphylactic shock">Anaphylactic shock</a></li> <li><a href="/wiki/Toxic_shock_syndrome" title="Toxic shock syndrome">Toxic shock syndrome</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Obstructive_shock" title="Obstructive shock">Obstructive</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Abdominal_compartment_syndrome" title="Abdominal compartment syndrome">Abdominal compartment syndrome</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Low-volume</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Hemorrhage" class="mw-redirect" title="Hemorrhage">Hemorrhage</a></li> <li><a href="/wiki/Hypovolemia" title="Hypovolemia">Hypovolemia</a> <ul><li><a href="/wiki/Osmotic_shock" title="Osmotic shock">Osmotic shock</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Cardiogenic_shock" title="Cardiogenic shock">Cardiogenic</a></li> <li><a href="/wiki/Spinal_shock" title="Spinal shock">Spinal shock</a></li> <li><a href="/wiki/Cryptic_shock" 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