Emergency Care:

Addisonian Crisis &

Adrenal Insufficiency
 Addisonian Crisis
Addisonian Crisis is an acute exacerbation
of symptoms in someone with Addisons
disease (namely adrenal insufficiency)
Whereas Cushings syndrome is seen in
patients with excess corticosteroids,
Addisons disease is seen in someone
with a deficiency in corticosteroids.
 Addisons Disease
Much like Thyroid disease, Addisons
disease is failure of some aspect the
complex system of hormones and
feedback loops
Also, like Thyroid disease, there may be
dysfunction as these hormones and
messengers interact with the
hypothalamus, pituitary and the site of
hormone release (in this case the adrenal
glands)
 Adrenal Function Summary
The Adrenal
Gland releases Androgens (sex
hormones)
Mineralocorticoids

Glucocorticoids

Glucocortoicoids Mineralcorticoids
(most potent is cortisol) (Aldosterone)
Action: anti-inflammatory, Action: Manages
growth suppressing, sodium/potassium balance
affects sleep patterns &
awareness, stress response
Connecting the dots
 Addisons Disease
Addisons disease can be a lack of all three
hormones or just glucocorticoids and
androgren

Caused by:
Destruction of the adrenal glands by
infection
Autoimmune attack
Mutation in the ACTH receptor on adrenal
cells
 Addisonian Crisis
Triggered by anything that increases the
persons normal stress level: surgery, infection,
emotional trauma, physical trauma as well as
sudden withdrawal from sterioids or post-
adrenalectomy
The body is unable to release sufficient cortisol
to respond appropriately
Result is: Hypotension, tachycardia,
dehydration, hypoglycemia, hyponatremia,
hyperkalemia, fever, weakness & confusion
May lead to shock & vascular collapse
 Addisonian Crisis:
Education/Nursing Care
Prevention through careful titration of
steroids
Steroid coverage for stressful events (i.e.
preoperatively, hot weather, flu, etc.)
Patient, family, friends aware of
signs/symptoms of crisis
Wallet card/med alert bracelet explaining
condition, medications, and how to
respond in an emergency
 Addisonian Crisis:
Education/Nursing Care
Treatment focuses on getting patient the
cortisol they need to have their body
respond appropriately (PO, IV, IM routes)
Patient should always carry emergency
dose, usually 100mg IM hydrocortisone
Return demonstration with normal saline
before discharge