title: [Addisonian crisis in patients with known adrenal insufficiency: the importance of early intervention].
abstract: In patients known to have adrenal insufficiency, inadequate adjustment of the glucocorticoid dosage during intercurrent illness can be life threatening. We describe two patients with adrenal insufficiency who died after their glucocorticoid dosage was insufficiently increased during an episode of gastroenteritis and pneumonia, respectively. Another patient died after a few days of fever and vomiting of unknown origin, after a period of refusing her medication. To prevent unnecessary death from Addisonian crisis, we have developed a protocol. Patients with known adrenal insufficiency, as well as their relatives and general practitioners, should repeatedly receive verbal and written instructions on how to deal with physical and severe psychic stress. We teach the patients and their relatives how to use an emergency injection of hydrocortisone, and the patients can consult the on-call endocrinologist by telephone 24 hours a day.
authors.affiliation: Universitair Medisch Centrum St Radboud, afd. Endocriene Ziekten, Postbus 9101, 6500 HB Nijmegen. a.hermus@endo.umcn.nl
authors.forename: A H
authors.initials: AH
authors.lastname: Mulder
authors.forename: S
authors.initials: S
authors.lastname: Nauta
authors.forename: G F
authors.initials: GF
authors.lastname: Pieters
authors.forename: A R M M
authors.initials: AR
authors.lastname: Hermus
mesh_terms: D000208:Acute Disease; D000224:Addison Disease / Q000188:drug therapy*; D000309:Adrenal Insufficiency / Q000150:complications / Q000188:drug therapy*; D000328:Adult; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors
chemical_list: D006854:Hydrocortisone