Adrenal Crisis (Addisonian Crisis)

Overview

• Presenter: Sarah, Registered Nurse (RN)
• Focus: Understanding adrenal crisis, its causes, symptoms, and nursing management important for the NCLEX and nursing exams.
• Resource: Quiz available at register nurse rn.com.

Key Components

• Adrenal Cortex: Part of the adrenal glands located atop the kidneys; produces cortisol.
• Pituitary Gland: Regulates cortisol production by releasing adrenocorticotropic hormone (ACTH).
• Cortisol: A steroid hormone (glucocorticoid) essential for stress response, metabolism of glucose, and regulation of electrolytes (sodium & potassium).

Negative Feedback Loop

1. Hypothalamus releases corticotropin-releasing hormone (CRH).
2. Pituitary Gland releases ACTH.
3. Adrenal Glands release cortisol.
4. Disruption in this loop can lead to adrenal crisis.

Causes of Adrenal Crisis

• Adrenal Cortex Damage: Often due to Addison's disease.
• Adrenalectomy: Removal of adrenal glands, often done for Cushing's syndrome.
• Pituitary Gland Damage: Impairs ACTH production, leading to low cortisol levels.

Signs and Symptoms

The Five S's

1. Severely Low Blood Pressure: Unresponsive to fluids or vasopressors.
2. Sudden Pain: Particularly in the stomach, back, and legs.
3. Syncope (Fainting):
4. Shock: Vascular collapse due to dehydration and low blood pressure.
5. Severe Vomiting, Diarrhea, and Headache:

The Three H's

1. Hyponatremia: Low sodium levels (<135).
2. Hypoglycemia: Low blood sugar (<70).
3. Hyperkalemia: High potassium levels (>5.1).

Nursing Management

1. Stabilization: Immediate administration of cortisol (Hydrocortisone IV).
2. IV Fluids: Typically D5 normal saline to address dehydration and hypoglycemia.
3. Oral Glucocorticoids: Transition from IV to oral (e.g., Prednisone, Hydrocortisone).
4. Mineralocorticoids (if needed): To supplement aldosterone, especially in Addison's disease (e.g., Florinef).

Patient Education

• Routine Cortisol Dosing: Avoid abrupt cessation.
• Stress Management: Increase dosage during periods of stress or illness.
• Sodium Intake: Important for those on Florinef.

Monitoring

• Glucose Levels: Risk of hypoglycemia.
• Potassium and Sodium Levels: Monitor for hyperkalemia and hyponatremia.
• Infection Prevention: Due to low cortisol levels affecting stress response.

Conclusion

• Action: Take the quiz to test understanding.
• Further Learning: Explore other endocrine series videos and subscribe for updates.