WordNet

an unstable situation of extreme danger or difficulty; "they went bankrupt during the economic crisis"
a crucial stage or turning point in the course of something; "after the crisis the patient either dies or gets better"
of or pertaining to the adrenal glands or their secretions
near the kidneys

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(社会上・政治上の)『重大な事態』,『難局』,危機 / (人生の)重大な転機(岐路),重大事 / 最悪状態
副腎(じん)の

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/05/08 03:24:42」(JST)

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Adrenal crisis (also known as Addisonian crisis and acute adrenal insufficiency) is a medical emergency and potentially life-threatening situation requiring immediate emergency treatment. It is a constellation of symptoms that indicate severe adrenal insufficiency caused by insufficient levels of the hormone cortisol.^[1] This may be the result of either previously undiagnosed or untreated Addison's disease, a disease process suddenly affecting adrenal function (such as bleeding from the adrenal glands in Waterhouse-Friderichsen syndrome), suddenly stopping intake of glucocorticoids, or an intercurrent problem (e.g. infection, trauma, in fact any form of physical or mental stress) in someone known to have Addison's disease or congenital adrenal hyperplasia (CAH).

Signs and symptoms

Characteristic symptoms are:^[2]

Sudden penetrating pain in the legs, lower back or abdomen
Confusion, psychosis, slurred speech
Severe lethargy
Convulsions
Fever
Hyperkalemia (elevated potassium level in the blood)
Hypercalcemia (elevated calcium level in the blood): the etiology of hypercalcemia is a combination of increased calcium input into the extracellular space and reduced calcium removal by the kidney, this last caused by decreased glomerular filtration and increased tubular calcium reabsorption. Both renal factors are secondary to volume depletion and, in fact, improve rapidly during rehydration with saline infusion.^[3]
Hypoglycemia (reduced level of blood glucose)
Hyponatremia (low sodium level in the blood)
Hypotension (low blood pressure)
Hypothyroid (low T4 level)
Severe vomiting and diarrhea, resulting in dehydration
Syncope (loss of consciousness and ability to stand)

Causes

It is caused due to deficiency of cortisol. Cortisol deficiency may be due to Addison's disease, Congenital adrenal hyperplasia (CAH), corticosteroid biosynthetic enzyme defects or pituitary disorders (such as Sheehan's syndrome, pituitary adenoma, hypopituitarism (inactive or underactive pituitary) causing failure to activate the adrenal glands.

Diagnosis

Various investigations aid the diagnosis.

ACTH (cosyntropin) stimulation test
Cortisol level (to assess the level of glucocorticoids)
Fasting blood sugar
Serum potassium (to assess the level of mineralocorticoids)
Serum sodium

Treatment

Acute adrenal insufficiency is a medical emergency and needs to be treated with injectable hydrocortisone and fluid support.^[1]

Prevention

Adrenal crisis is triggered by physiological stress (such as trauma). Activities that have an elevated risk of trauma are best avoided. Treatment must be given within two hours of trauma and consequently it is advisable to carry injectable hydrocortisone in remote areas.^[4]

Epidemiology

Hahner et al. investigated the frequency, causes and risk factors for adrenal crisis in patients with chronic adrenal insufficiency.^[5] Annane et al.'s landmark 2002 study found a very high rate of relative adrenal insufficiency among the enrolled patients with septic shock.^[6]

References

^ ^a ^b "Acute adrenal crisis (Addisonian crisis)". Endocrine Surgery Encyclopedia. UCLA Health System. Retrieved 14 August 2013.
^ "Addison's Disease". National Endocrine and Metabolic Diseases Information Service. Retrieved 14 August 2013.
^ http://link.springer.com/article/10.1007%2FBF02411297
^ Hydrocortisone The Pituitary Foundation, UK
^ Hahner, S.; Loeffler, M.; Bleicken, B.; Drechsler, C.; Milovanovic, D.; Fassnacht, M.; Ventz, M.; Quinkler, M.; Allolio, B. (2 December 2009). "Epidemiology of adrenal crisis in chronic adrenal insufficiency: the need for new prevention strategies". European Journal of Endocrinology 162 (3): 597–602. doi:10.1530/EJE-09-0884. PMID 19955259.
^ Annane, D. (20 August 2002). "Effect of Treatment With Low Doses of Hydrocortisone and Fludrocortisone on Mortality in Patients With Septic Shock". JAMA: the Journal of the American Medical Association 288 (7): 862–871. doi:10.1001/jama.288.7.862. PMID 12186604.

External links

Acute adrenal crisis on PubmedHealth
Adrenal Crisis on Patient.info
Katherine White (28 July 2004). "What to do in an emergency -Addisonian crisis". Addison's Disease Self Help Group (ADSHG).
Addisonian crisis on rightdiagnosis.com

UpToDate Contents

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1. 成人における副腎不全の臨床症状 clinical manifestations of adrenal insufficiency in adults
2. 成人における副腎不全の治療 treatment of adrenal insufficiency in adults
3. 小児における副腎不全の治療 treatment of adrenal insufficiency in children
4. 成人における副腎不全の診断 diagnosis of adrenal insufficiency in adults
5. 悪心および嘔吐を呈する幼児または小児に対するアプローチ approach to the infant or child with nausea and vomiting

English Journal

Reduction in daily hydrocortisone dose improves bone health in primary adrenal insufficiency.

Schulz J1, Frey KR1, Cooper MS1, Zopf K1, Ventz M1, Diederich S1, Quinkler M2.
European journal of endocrinology / European Federation of Endocrine Societies.Eur J Endocrinol.2016 Apr;174(4):531-8. doi: 10.1530/EJE-15-1096. Epub 2016 Jan 25.
OBJECTIVE: Individuals with primary adrenal insufficiency (PAI) or congenital adrenal hyperplasia (CAH) receive life-long glucocorticoid (GC) replacement therapy. Current daily GC doses are still higher than the reported adrenal cortisol production rate. This GC excess could result in long-term morb
PMID 26811406

Identification of five novel STAR variants in ten Chinese patients with congenital lipoid adrenal hyperplasia.

Huang Z1, Ye J1, Han L1, Qiu W1, Zhang H1, Yu Y1, Liang L1, Gong Z1, Gu X2.
Steroids.Steroids.2016 Apr;108:85-91. doi: 10.1016/j.steroids.2016.01.016. Epub 2016 Jan 28.
Congenital lipoid adrenal hyperplasia (CLAH) is a rare autosomal recessive disorder caused by defective synthesis of all steroids. This disorder is characterized by 46,XY sex reversal, skin hyperpigmentation, early-onset adrenal crisis and enlarged adrenal with fatty accumulation. CLAH is caused by
PMID 26827627

Bladder paraganglioma: safe and feasible management with robot assisted surgery.

Bishnoi K1, Bora GS1, Mavuduru RS2, Devana SK1, Singh SK1, Mandal AK1.
Journal of robotic surgery.J Robot Surg.2016 Mar 23. [Epub ahead of print]
Pheochromocytomas of extra-adrenal origin are known as paragangliomas. Urinary bladder is the most common site of genitourinary paragangliomas. The variable functional status of these tumors presents a surgical challenge in their management by minimally invasive surgery. Robot-assisted partial cyste
PMID 27007467