Addisonian crisis is a rare but life-threatening endocrine emergency that can occur in patients with adrenal insufficiency. It is characterized by a sudden onset of severe symptoms, including hypotension, hyponatremia, hyperkalemia, and metabolic acidosis. Nurses play a crucial role in recognizing and managing this condition, as early diagnosis and treatment can be life-saving.
Addisonian crisis is an endocrine emergency triggered by an acute episode of adrenal insufficiency.
Common causes of adrenal crisis
Common causes of adrenal crisis include:
Progression of undiagnosed adrenal insufficiency
Known adrenal insufficiency complicated by a stressful event and failure to adjust chronic steroid dose
Sudden discontinuation of long-term systemic corticosteroid therapy
Chronic infection, such as tuberculosis, leading to infectious adrenalitis
Addisonian crisis symptoms
Nursing tip: Maintain suspicion for adrenal crisis in any client presenting in a critically ill state with signs of shock.
Symptoms of Addisonian crisis can include severe abdominal pain, vomiting, diarrhea, low blood pressure, confusion, and potentially loss of consciousness.
Nursing tips regarding Addisonian crisis
Collect a thorough history, including history of Addison’s disease and chronic steroid therapy, recent illness, injury, or stressor, family or personal history of autoimmune conditions.
Efficiently facilitate diagnostic lab work, blood cultures, ECG, and imaging as ordered.
Definitive diagnosis is not always possible in the moment of acute adrenal crisis. If suspected, treatment should not be delayed.
Addisonian crisis lab values
In Addisonian crisis, lab tests often show:
Low serum sodium (hyponatremia)
High serum potassium (hyperkalemia)
Low blood glucose (hypoglycemia)
High serum cortisol levels following an ACTH stimulation test will rule out Addison’s crisis, while low levels confirm it.
Addisonian crisis treatment
Treatment measures include:
Fluid resuscitation normal saline of 5% dextrose in NS, in the setting of hypoglycemia
IV glucocorticoid replacement
If caused by adrenal insufficiency symptoms should resolve quickly with fluid replacement and IV steroid administration.
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