Addisonian crisis

Acute adrenal insufficiency (also known as adrenal crisis or Addisonian crisis) represents a true endocrine emergency. 

IV.a.1.9. Adrenal suppression. It results from inhibition of pituitary ACTH secretion, and some suppression of the normal adrenal response to stress may persist for years after stopping therapy. Rapid withdrawal of corticosteroid therapy can therefore precipitate dangerous acute adrenal insufficiency ( Addisonian crisis , with hypotension, vomiting, coma and ultimately death), and for this reason steroid treatment should always be reduced gradually, sometimes over many months, according to the dose and duration of therapy. 

Adrenal insufficiency can be associated with hypothyroidism (either by autoimmune destruction or due to hypophyseal disease) and carries the risk of acute Addisonian crisis if thyroid substitution precedes glucocorticoid therapy. The diagnostic problem presented by the fact that a few patients with central hypothyroidism have a moderately increased serum TSH should be kept in mind (62). 

The emergency department nurse is caring for a client in an Addisonian crisis. 

The nurse must treat an Addisonian crisis as all other shock sitnations. An IV and flnid replacement are imperative to prevent or treat shock. This is the first action. 

To avoid adrenal insufficiency or Addisonian crisis, the client must taper the medication. 

If you continue taking the medication, it may cause an Addisonian crisis. ... 

An Addisonian crisis (adrenal insufficiency) is a complication that may occur... 

Destruction of the adrenal cortex results in a deficiency of glucocorticoids, mineralocorticoids and androgens, and the features of the disease are a reflection of this. Mineralocorticoid deficiency leads to sodium deficiency, which in turn leads to dehydration and this can present as an Addisonian crisis. The deficiency of glucocorticoids leads to hypoglycaemia and pronounced insulin sensitivity with a flat glucose tolerance curve. Because of the glucocorticoid deficiency, the pituitary produces maximal... 

Kyriazopoulou V, Parparousi O, Vagenakis AG. Rifampicin-induced adrenal crisis in Addisonian patients receiving corticosteroid replacement therapy. J Clin Endocrinol Metab 1984 59(6) 1204-6. 

---