Podcast 548:  Adrenal Crisis

<p><strong>Contributor: Nick Tsipis, MD</strong></p> <p><strong>Educational Pearls:</strong></p> <ul> <li style="font-weight: 400;"><span style= "font-weight: 400;">Congenital adrenal hyperplasia (CAH) is a group of enzyme deficiencies in the adrenals leading to a deficiency of hormones normally synthesized by the adrenals (mineralocorticoids, glucocorticoids, androgens)</span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">21-hydroxylase is most commonly the deficient enzyme.</span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">21-hydroxylase is needed to produce aldosterone and cortisol, and those with chronic cortisol deficiencies need daily steroid replacement</span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Aldosterone, made in the kidney as part of the renin-angiotensin-aldosterone system (RAAS), increases blood pressure via salt and water retention to maintain adequate organ perfusion</span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Adrenal crisis results in a loss of cortisol leading to hypoglycemia and potential CNS depression with hypotension, hypoglycemia, and hyponatremia</span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Patients in adrenal crisis need salt, volume, and glucose replacement</span></li> </ul> <p><strong>References</strong></p> <p><span style="font-weight: 400;"><span style= "font-size: 10pt;">Martin-Grace, J.,</span></span> <span style= "font-size: 10pt;"><em><span style="font-weight: 400;">et al</span></em><span style="font-weight: 400;">. Adrenal insufficiency: physiology, clinical presentation and diagnostic challenges.</span> <em><span style="font-weight: 400;">Clin Chim Acta</span></em><span style="font-weight: 400;">. 2020 Feb 6. </span></span></p> <p><span style="font-weight: 400; font-size: 10pt;">Dineen, R., Thompson, C.J., Sherlock, M. Adrenal crisis: prevention and management in adult patients. Ther Adv Endocrinol Metab. 2019 Jun 13;10:2042018819848218.</spa