title: Adrenal crisis provoked by dental infection: case report and review of the literature.
abstract: Primary adrenal insufficiency is an endocrine disorder characterized by cortisol and aldosterone deficiency caused by destruction of the adrenal cortex. Adrenal crisis is a medical emergency with acute symptoms: nausea, vomiting, abdominal pain, fever, hypoglycemia, seizures, hypovolemic shock, and cardiovascular failure. It occurs in patients with chronic adrenal insufficiency who are exposed to additional stress, such as infection, trauma, or surgical procedures. Dental infection is a possible cause of adrenal crisis in patients with chronic adrenal insufficiency, so pediatric endocrinologists and pediatric dentists should be aware of this risk. The purpose of this report was to present a 6-year-old patient in whom Addison disease was diagnosed through adrenal crisis provoked by dental infection. The patient was treated with intravenous rehydration, intravenous hydrocortisone and antibiotics, and extraction of the infected primary tooth. Multidisciplinary approach and collaboration between the pediatric endocrinologist and the pediatric dentist are necessary to enable adequate medical and dental treatment in children with primary adrenal insufficiency.
authors.affiliation: Department of Pediatric and Preventive Dentistry, Faculty of Dentistry, University of Belgrade, Belgrade, Serbia. ana.milenkovic@yahoo.com
authors.forename: Ana
authors.initials: A
authors.lastname: Milenkovic
authors.forename: Dejan
authors.initials: D
authors.lastname: Markovic
authors.forename: Dragan
authors.initials: D
authors.lastname: Zdravkovic
authors.forename: Tamara
authors.initials: T
authors.lastname: Peric
authors.forename: Tatjana
authors.initials: T
authors.lastname: Milenkovic
authors.forename: Rade
authors.initials: R
authors.lastname: Vukovic
mesh_terms: D000208:Acute Disease; D000224:Addison Disease / Q000175:diagnosis* / Q000188:drug therapy; D000309:Adrenal Insufficiency / Q000188:drug therapy / Q000209:etiology*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D020249:Hormone Replacement Therapy; D006801:Humans; D006854:Hydrocortisone / Q000627:therapeutic use*; D007239:Infections / Q000150:complications / Q000188:drug therapy / Q000473:pathology; D008297:Male; D014076:Tooth Diseases / Q000150:complications* / Q000473:pathology / Q000601:surgery; D014081:Tooth Extraction; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D006854:Hydrocortisone