The Addison Crisis

introduction

Addison's crisis is a dreaded complication of adrenal insufficiency. In general, it is more of a rare, if acute disease picture, which is characterized by a severe lack of cortisol.

The Addison's crisis, or severe cortisol deficiency, is a life-threatening condition that requires immediate medical treatment.

Find out more about the topic here: Addison's disease - all important information summarized.

causes

The cause of the Addison's crisis is the lack of the hormone Cortisol. This is made in the adrenal cortex.

In some people, the production of the hormone does not work properly. The loss of function can be caused by a disorder in the adrenal gland itself or in the pituitary gland. The pituitary gland is part of the human brain and influences the production of cortisol in the adrenal cortex through the release of the hormone ACTH (adrenocorticotropic hormone). If ACTH is not produced, the adrenal cortex lacks the signal to produce cortisol. An Addison's crisis occurs primarily in people who have such a disorder. So you have too little cortisol, which has to be compensated for by administering cortisol in drug form.

When it comes to cortisol, the stress hormone is also often used. In conditions in which the body has a higher need for cortisol, the amount available is then no longer sufficient.

Situations that can cause an Addison Crisis are for example

• a feverish infection,
• psychological stress,
• heavy physical exertion,
• Vomiting and diarrhea
• severe injuries
• and operations.

People who have not yet been diagnosed with adrenal insufficiency are particularly susceptible to an Addison's crisis. But patients who are already receiving treatment can also suffer from an Addison's crisis. This happens when the amount of cortisol supplied does not really cover the need in stressful situations.

To understand the roles and importance of the adrenal gland, also read our article: The function of the adrenal gland.

After administration of cortisol

The Addison's crisis is caused by an acute lack of cortisol, especially in people whose adrenal glands can no longer properly produce cortisol. After administration of cortisol, there is usually no Addison's crisis.

Inconsistent use of cortisone in adrenal insufficiency or a stressful situation that requires a higher amount of cortisol can cause a crisis. The administration of cortisol is then one of the most important treatment measures to avert the life-threatening condition of those affected.

diagnosis

Immediate presentation to the doctor or even direct admission to the hospital is necessary if an Addison crisis is suspected.

The typical symptoms such as

• Fever,
• Clouding of consciousness and
• Decrease in blood pressure associated with a known disease of the adrenal cortex or pituitary gland.

An Addison crisis can also be characterized by hypoglycaemia and shock.

The regular intake of cortisol or the sudden discontinuation of therapy can, in combination with the above-mentioned symptoms, also indicate an Addison crisis.

If there is no known adrenal insufficiency, diagnosis can be more difficult. In particular, the determination of cortisol and ACTH values ​​can make a decisive contribution to the diagnosis. Furthermore, the function of the adrenal gland can be measured with a special test, the ACTH test. However, this is a special measure that is only carried out if there is an urgent suspicion of an Addison crisis. The use of ultrasound and, if necessary, CT or MRT can also be used as diagnostic tools. Above all, it is checked whether the adrenal gland is enlarged or perhaps. a tumor is responsible as the cause of the hypofunction.

Read more about the topic here: secondary adrenal insufficiency.

I recognize an Addison's crisis by the following symptoms

The Addison's crisis is characterized by a variety of symptoms. These include:

• Clouding of consciousness,
• high temperature or fever,
• Nausea or vomiting and
• Diarrhea.

Furthermore, a drop in blood pressure often occurs, which can lead to the affected person in a state of shock.

Hypoglycemia or, in medical terminology, so-called hypoglycaemia and dehydration (too little water in the body) can also occur in the context of an Addison crisis.

also read: The symptoms of hypoglycaemia.

So-called pseudoperitonitis can also appear. This is severe pain in the abdomen, usually caused by inflammation of the peritoneum. In the Addison crisis, similar pain symptoms can occur without the presence of a corresponding inflammation - this is why we speak of so-called “non-real” peritonitis or pseudoperitionits.

In particular, patients who have already been diagnosed with adrenal insufficiency should be made aware of the above symptoms. An immediate presentation to the doctor is then urgently recommended.

An Addison's crisis with its typical symptoms often develops, however, especially in people who have not yet been informed about the underfunction of their adrenal cortex. It is then difficult for those affected to relate the symptoms or they may be misinterpreted. Especially when the Addison's crisis occurs when the disease has not yet been diagnosed, those affected can be at great risk.

Read more on the subject below: The symptoms of Addison's disease.

therapy

An Addison crisis requires emergency treatment for the person affected. The most important measures include

• the administration of cortisol,
• fluid substitution,
• Medicines to stabilize the circulation
• and in some cases also the administration of oxygen.

Furthermore, the reasons for an Addison crisis must be clarified. Accordingly, an examination of the function of the adrenal gland and pituitary gland is carried out. Finding the cause is an important part of treatment in order to be able to counteract future crisis situations effectively.

Education about the correct medication intake and dosage in stressful situations is also part of the treatment process. If necessary, the affected person will be given an emergency pen for future stressful situations. This is a cortisone injection that can be used by those affected in acute situations. The attending physician will explain the procedure for administering the emergency medication to those affected in detail.

Duration and prognosis

The duration and prognosis of an Addison crisis cannot be predicted across the board.

People are often monitored in intensive care and it may take some time for the body to recover.

However, the Addison's crisis can also lead to the death of those affected, especially if it is left untreated or treated too late. It is for this reason that the immediate initiation of therapy with special intensive medical treatment is so extremely important.

How dangerous can an Addison crisis be?

An Addison crisis is a life-threatening condition. Without therapy, the majority of those affected would die. Immediate treatment is therefore extremely important.

The administration of cortisone, medication to stabilize the circulation and fluids tries to remedy the cortisol deficiency in the body. The patients are usually monitored by intensive care during the treatment phase.

Despite therapeutic measures, especially if they start much too late, in a few cases the affected person can still die.