Adrenal Gland Crisis

     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].

     The human endocrine system is a powerful network that enables people to function normally every day.  Disturbance of that regulation may antecede situations that require aggressive  therapy in a critical care facility.

1. Wiebke, A. and the Society for Endocrinology Clinical Committee.  (2016).  Emergency management of acute adrenal insufficiency (adrenal crisis) in adult patients.  Endocrine Connections, 5:  G1-G3.
2. Zaghlol, R., Tierney, M., Zaghlol, L. and Zayed, A.  (2018).  A 71-year-old woman with shock and a high INR.  Cleveland Clinic Journal of Medicine, 85, 303-312.
3. The photo shows a library at the U.S. Centers for Disease Control, and reprint is with permission from that organization.
4. Copyright 2018 Michael Koger, Sr.  All rights reserved.

     The information contained in this article is for educational purposes only and not for diagnosis or to guide treatment without the opinion of a health professional. Any reader who is concerned about his or her health should contact their physician for advice.