Acute adrenal insufficiency: literature analysis

Diana Bukauskaite1, Ugne Grimutiene1, Goda Jakovlevaite1

1 Lithuanian University of Health Sciences, Academy of Medicine, Faculty of Medicine, Kaunas, Lithuania


Acute adrenal insufficiency (AAI) also known as adrenal or addisonian crisis, is an acute and life – threatening condition. AAI is most common in people who already have chronic adrenal insufficiency (CAI), when the organism is affected by stress and is unable to provide the required amount of endogenous cortisol or replacement therapy is insufficient. In patients without CAI, AAI can be caused by infectious adrenalitis, fibrosis or Waterhouse – Friderichsen syndrome. Clinical features of AAI occur rapidly, within a few hours, the main clinical sign being fluid and vasopressor uncontrolled shock. Other nonspecific symptoms include weakness, dehydration, nausea, vomiting, abdominal pain, tachycardia, cramps, apathy, disorientation, coma and signs of CAI. A medical history, patient examination and laboratory tests, especially cortisol level determination, are important for diagnosis of AAI. Treatment, even in the absence of a confirmed diagnosis, is initiated with parenteral glucocorticoid administration and correction of rehydration. Depending on the severity and causes of AAI, treatment in intensive care units, symptomatic causation treatment, prevention of thromboembolism and stress ulcers, etc. should be considered. AAI management should focus on the prevention of acute and life – threatening events, systematic training of the patient, his family and friends is an essential prevention tool.

Aim: To analyse the scientific literature about  the etiology, diagnostic methods  and treatment of  acute adrenal insufficiency.

Methods: literature sources were selected from PubMed and Cochrane Library scientific databases, selecting only reviews from 2015 to 2020 in English, using the keywords in the original language: “adrenal insufficiency”, “acute adrenal insufficiency”, “addisonian crisis”, “adrenal crisis”, “adrenal glands”.

Keywords: Adrenal insufficiency, acute adrenal insufficiency, addisonian crisis, adrenal crisis, adrenal glands.