Not only is cortisol insufficiency a factor in all of this, but also mineralocorticoid disturbance takes place because secretion of aldosterone production is too low. The adrenal gland regulates these and other substances via certain layers of tissue all of which operate according to the type of cells that handle those chemicals. This is obviously a complex network of hormones and endocrine glands. Scientists have studied it with keen interest for decades [1, 2].
Of the many possibilities that may herald adrenal crisis, one must remember that long-term therapy with steroids is an important consideration. Specifically, topical creams that one may apply to the skin can interfere with the normal regulation of these hormones. At least four weeks of prednisolone treatment for certain conditions in a dose of 5 milligrams daily can also lead to the problem. Also, therapeutic glucocorticoid injections into joints over a long period of time can result in steroid dependence [1, 2].
Essentially, steroid dependence leaves the patient in a serious situation whenever these hormone treatments stop abruptly. Such a situation may occur after surgery unless the health care team resumes glucocorticoid therapy after the operation. Either way, this chronic exogenous treatment mandates close evaluation from the physician in order to ensure a smooth transition after surgery [1, 2].
Additionally, whenever a patient presents with shock of any kind, the team must consider adrenal crisis as a possibility, and quick intervention is necessary to prevent further progression of this critical illness [1, 2].