title: Adrenal Crisis: Still a Deadly Event in the 21st Century.
abstract: Adrenal crisis is a life-threatening medical emergency, associated with a high mortality unless it is appropriately recognized and early treatment is rendered. Despite it being a treatable condition for almost 70 years, failure of adequate preventive measures or delayed treatment has often led to unnecessary deaths. Gastrointestinal illness is the most common precipitant for an adrenal crisis. Although most patients are educated about "sick day rules," patients, and physicians too, are often reluctant to increase their glucocorticoid doses or switch to parenteral injections, and thereby fail to avert the rapid deterioration of the patients' condition. Therefore, more can be done to prevent an adrenal crisis, as well as to ensure that adequate acute medical care is instituted after a crisis has occurred. There is generally a paucity of studies on adrenal crisis. Hence, we will review the current literature, while also focusing on the incidence, presentation, treatment, prevention strategies, and latest recommendations in terms of steroid dosing in stress situations.
authors.affiliation: Division of Endocrinology, Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Endocrinology, Changi General Hospital, Singapore. Electronic address: Troy_puar@cgh.com.sg.
authors.forename: Troy H K
authors.initials: TH
authors.lastname: Puar
authors.affiliation: Division of Endocrinology, Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Nike M M L
authors.initials: NM
authors.lastname: Stikkelbroeck
authors.affiliation: Department of Internal Medicine and Endocrinology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Lisanne C C J
authors.initials: LC
authors.lastname: Smans
authors.affiliation: Department of Internal Medicine and Endocrinology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Pierre M J
authors.initials: PM
authors.lastname: Zelissen
authors.affiliation: Division of Endocrinology, Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Ad R M M
authors.initials: AR
authors.lastname: Hermus
mesh_terms: D000309:Adrenal Insufficiency / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control / Q000628:therapy*; D000324:Adrenocorticotropic Hormone / Q000097:blood; D004630:Emergencies; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D006854:Hydrocortisone / Q000097:blood / Q000627:therapeutic use; D007552:Isotonic Solutions; D010353:Patient Education as Topic; D012307:Risk Factors; D012646:Self Administration; D012965:Sodium Chloride / Q000008:administration & dosage
chemical_list: D005938:Glucocorticoids; D007552:Isotonic Solutions; D012965:Sodium Chloride; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone
keywords: Adrenal crisis; Adrenal insufficiency; Crisis; Emergency