Emergency care addisonian crisis adrenal insufficiency
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Emergency Care: Addisonian Crisis & Adrenal Insufficiency. Addisonian Crisis. Addisonian Crisis is an acute exacerbation of symptoms in someone with Addison’s disease (namely adrenal insufficiency)

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Addisonian crisis
Addisonian Crisis

  • Addisonian Crisis is an acute exacerbation of symptoms in someone with Addison’s disease (namely adrenal insufficiency)

  • Whereas Cushing’s syndrome is seen in patients with excess corticosteroids, Addison’s disease is seen in someone with a deficiency in corticosteroids.

Addison s disease
Addison’s Disease

  • Much like Thyroid disease, Addison’s disease is failure of some aspect the complex system of hormones and feedback loops

  • Also, like Thyroid disease, there may be dysfunction as these hormones and messengers interact with the hypothalamus, pituitary and the site of hormone release (in this case the adrenal glands)

Adrenal function summary
Adrenal Function Summary

The Adrenal Gland releases…

Androgens (sex hormones)




(most potent is cortisol)

Action: anti-inflammatory,

growth suppressing,

affects sleep patterns &

awareness, stress response



Action: Manages

sodium/potassium balance

Addison s disease1
Addison’s Disease

Addison’s disease can be a lack of all three hormones or just glucocorticoids and androgren

Caused by:

  • Destruction of the adrenal glands by infection

  • Autoimmune attack

  • Mutation in the ACTH receptor on adrenal cells

Addisonian crisis1
Addisonian Crisis

  • Triggered by anything that increases the person’s normal stress level: surgery, infection, emotional trauma, physical trauma as well as sudden withdrawal from sterioids or post-adrenalectomy

  • The body is unable to release sufficient cortisol to respond appropriately

  • Result is: Hypotension, tachycardia, dehydration, hypoglycemia, hyponatremia, hyperkalemia, fever, weakness & confusion

  • May lead to shock & vascular collapse


  • Review the provided education sheet from the Addison’s Disease Self-Help Group

  • http://www.adshg.org.uk/info/manual/crisismanagement.pdf

  • Review the last three slides

  • Fill in your worksheet

Addisonian crisis education nursing care
Addisonian Crisis: Education/Nursing Care

  • Prevention through careful titration of steroids

  • “Steroid coverage” for stressful events (i.e. preoperatively, hot weather, flu, etc.)

  • Patient, family, friends aware of signs/symptoms of crisis

  • Wallet card/med alert bracelet explaining condition, medications, and how to respond in an emergency

Addisonian crisis education nursing care1
Addisonian Crisis: Education/Nursing Care

  • Treatment focuses on getting patient the cortisol they need to have their body respond appropriately (PO, IV, IM routes)

  • Patient should always carry emergency dose, usually 100mg IM hydrocortisone

  • Return demonstration with normal saline before discharge

Highly recommended
Highly Recommended !!!

  • Review Corticosteroid Therapy on pp. 1332-1334

  • Probably don’t remember the information from when you were in Pharm

  • Will help you on test and on NCLEX

  • Key information in caring for patients who are taking corticosteroids