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Addisonian Crisis

Definition of Addisonian Crisis

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Addisonian crisis is another term for acute adrenocortical insufficiency, hypoadrenalism, and hypocortisolism. Based on statistics, Addisonian crisis is a rare disease and occurs in both women and men alike. It is a disease that affects the adrenal glands and leads to the underproduction of steroid hormones. It is categorized into two types: primary and secondary adrenal insufficiency.

Because this kind of disease condition progresses slowly, the symptoms are usually ignored until they reach a severe form of the disease condition which leads to life-threatening and overwhelming complications.

Other experts would define it as a life-threatening disease condition that occurs when a person has insufficient amount of cortisol, a hormone that is being produced by the adrenal glands. Moreover, people who suffer from Addisonian crisis experience chronic deficiencies of mineralocorticoid and glucocorticoid.

Addisonian Crisis Signs and Symptoms

People who experience Addisonian crisis will report the following symptoms and signs:

  • Fever
  • Confusion
  • Weakness
  • Hypoglycemia
  • Hyperkalemia
  • Tachycardia
  • Hyponatremia
  • Dehydration
  • Hypotension
  • Unintentional weight loss
  • Chills
  • Nausea
  • Loss of consciousness
  • Headache
  • Flank pain
  • Anorexia
  • Chronic constipation
  • Dizziness
  • Vertigo
  • Joint pain
  • Excessive and unusual facial or palmar sweating
  • Slow movement
  • Vomiting
  • Abdominal pain
  • Skin hyperpigmentation
  • Salt craving
  • Diarrhea
  • Irritability
  • Decreased appetite
  • Depression

Addisonian Crisis Causes

Researchers have grouped the etiological factors of Addisonian crisis into categorical groups. For example:

  • Impaired steroidogenesis

Scientifically, cortisol is formed by the adrenal glands. To form cortisol, cholesterol is needed to be biochemically converted into hormones, particularly steroid hormones. When the cholesterol production is interrupted, cortisol is not produced, leading to impaired steroidogenesis.

  • Adrenal dysgenesis

This is another cause of Addisonian crisis. This categorical group type is genetic in origin, and such causes are rare. The gene responsible for this kind of the disease includes DAX-1 gene, ACTH receptor gene, and SF1 transcription factor.

  • Destruction of the adrenal

This is a known etiological reason for people who have Addison’s disease. The destruction of the adrenal cortex is caused by an immune reaction.

  • Corticosteroid withdrawal

When a person uses high dosages of steroid for one or more weeks, he or she will likely produce an adrenal gland suppression due to the presence of exogenous glucocorticoids which is known to suppress the hypothalamic corticotrophin-releasing hormone and pituitary adrenocorticotropic hormone (ACTH). When there is prolonged suppression of the adrenal glands, its atrophy occurs, and the adrenal glands may need more time to reach their recuperation stage.

An impaired organ or medication withdrawal can lead to Addisonian crisis, so it is very important for people to be informed about the disease.

Addisonian Crisis Treatment

The treatment for Addisonian crisis involves hormonal replacement treatment which is used to correct the steroid hormonal level. The treatment options include the following:

Pharmacological treatment

Androgen replacement treatment

People with Addisonian crisis need androgen replacement treatment such as dehydroepiandrosterone. Furthermore, it improves sexual and libido satisfaction.

Corticosteroid injections

This will treat the low corticosteroid level found in people with Addisonian crisis.

Oral corticosteroids

The physician may prescribe fludrocortisones to replace aldosterone. Other medications include prednisone, cortisone acetate, and hydrocortisone.

Antibiotic treatment

This may be given if the cause of the Addisonian crisis is due to infection.

Other medications include the following:

    • Hydrocortisone
    • Dextrose
    • Saline solution

These are the common treatments given to people with Addisonian crisis. The treatments are basically symptomatic in approach.

Risks of Addisonian Crisis

The following are the risk factors associated with Addisonian crisis:

  • Trauma
  • Dehydration
  • Surgical procedure
  • Infection
  • Physical stress
  • pituitary gland or adrenal injury
  • Termination of steroid treatments
  • Cancer
  • Family medical history of Addison’s disease
  • Tuberculosis
  • Thyroid disease
  • Diabetes

Those who are at risk of Addisonian crisis should be informed about this condition, the treatment of this disease, and its prevention.

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