definition

Risk factors causes

ADRENAL manifestations
pathophysiology
CRISIS

Diagnostic and
Management
lab exams
 Addisonian Crisis
Also known as acute adrenal
insufficiency, may occur when the
client has been under stress without
appropriate hormone replacement.
 Adrenocortical hormone deficiency
results in the reverse of these hormonal
effects: glucocorticoids (cortisol),
mineralocorticoids (aldosterone, 11-
deoxycorticosterone), and androgens
(dehydroepiandrosterone).
Causes
Rapid withdrawal of long-term steroid
therapy

Direct injury to adrenal cortex

Rifampin

Septic shock
Risk Factors
Pregnancy
Surgery
Direct injury to adrenal cortex
Autoimmune diseases
Infection
States of dehydration or anorexia
Fever
Emotional upheaval
Manifestations
Abdominal pain
Confusion or coma
Darkening of the skin
Dehydration
Dizziness or light-headedness
Fatigue
Flank pain
Headache
High fever
Joint pain
Loss of appetite
Loss of consciousness
Low blood pressure
Nausea
Profound weakness
Rapid heart rate
Rapid respiratory rate
Shaking chills
Skin rash or lesions
Slow, sluggish movement
Unintentional weight loss
Unusual and excessive sweating
on face or palms
Vomiting
 Diagnostics and laboratory
exams
• Serumchemistry
• Serum cortisol
• ACTH test
• CBC
• Serum thyroid levels
• Serum thyroid levels

• Chest radiography
• Abdominal CT scanning
 Pathophysiology
Predisposing factors: Precipitating factors:
 Autoimmune disease  Direct trauma to
 Stressors adrenal cortex
 Excessive use/abrupt  Suppression of
withdrawal of exogenous hypothalamic pituitary
steroids adrenal axis
 metastatic carcinoma  pituitary gland injury
 idiopathic atrophy(most
frequent cause)

Adrenal exhaustion
 Destruction of the adrenal gland
function

Failure of adrenal glands to release adequate amounts

of hormones
Insufficient availability of steroid
hormones ( most importantly the
cortisol)

Adrenal crisis or
acute adrenal
insufficiency
 MEDICATIONS

Glucocorticoids
Mineralocortico Vasopr Antib
ids
essors iotics
 Medications:
1. Glucocorticoids
 Hydrocortisone – raises adrenocorticoid
hormonal levels. It is administered intravenously.
Restoration of BP and general improvement
should occur within 1 h after the initial dose of
hydrocortisone.
2. MINERALOCORTICOID
Fludrocortisone (Florinef) - Acts on renal distal
tubules to enhance reabsorption of sodium.
Increases urinary excretion of both potassium and
hydrogen ions. The consequence of these 3 primary
effects, together with similar actions on cation
transport in other tissues, appears to account for
the spectrum of physiological activities
characteristic of mineralocorticoids. Produces
marked sodium retention and increased urinary
potassium excretion.
3. VASOPRESSORS
Dopamine (Intropin) - Stimulates both
adrenergic and dopaminergic receptors of the
sympathetic NS thus increase cardiac output and
BP. Hemodynamic effect is dependent on the dose.
4. ANTIBIOTICS - may be administered if infection
has precipitated the occurrence of adrenal crisis.
 IV FLUIDS
 
1. D5 / D10 glucose – for aggressive fluid replacement
and for Immediate intravascular volume expansion.

2. 0.9% NSS –for the treatment of hypotension,

dehydration, and hyponatremia and for electrolyte
imbalances.
 Assessment and
Monitoring

Neurological Laboratory
Vital signs Intake & output
status values
 Nursing Interventions

1. Monitor vital signs especially BP - Lying,

sitting, and standing BP; a decrease in systolic BP
of 20 mmHg or more indicate fluid volume
depletion.
 •Monitor neurological status, noting irritability and confusion.

 
2. Assess skin turgor, mucous membranes, weight;
report increased thirst indicates impending fluid
imbalance.

3. Monitor neurological status, noting irritability

and confusion.
 4. Monitor intake and output.

5. Monitor laboratory values –

sodium, potassium, and blood glucose.
 6. Prevent infection - Avoid exposure to
chickenpox or measles and other infectious
diseases; if exposed, seek medical advice
without delay.
 7. Bed rest and quiet environment - Until
condition is stable, take precautions to avoid
unnecessary activity and stress that could
precipitate hypotensive episode. During acute
crisis, maintain a quiet, nonstressful
environment and performs all activities for the
patient.
 END
Prepared by:
Mitchell Fuertes
Gladys Dorilag
Wenna Rose Dongor
Jo Hiñola
BSN 4A