DRG Category: 644
Mean LOS: 5.3 days
Description MEDICAL: Endocrine Disorders with CC
Acute adrenal crisis is a life-threatening endocrine emergency caused by a deficit of glucocorticoids (primarily cortisol) or mineralocorticoids (primarily aldosterone). The anterior pituitary gland produces adrenocorticotropic hormone (ACTH), which causes the adrenal cortex to produce more than 50 steroid hormones. Cortisol and aldosterone are the most physiologically active of these hormones. In primary adrenocortical insufficiency, glucocorticoid and mineralocorticoid function is lost. Acute adrenocortical insufficiency is a difficult diagnosis to make. Acute adrenal crisis rarely occurs without an accompanying serious injury or illness. The diagnosis is difficult because many of the signs and symptoms are nonspecific. However, left untreated, someone with acute adrenal insufficiency has a very poor prognosis for survival. Any delay in disorder management while waiting for diagnostic confirmation may threaten the person's life.
Glucocorticoids are cardiac stimulants that activate release of essential vasoactive substances. Without corticosteroids, stress results in hypotension, shock, and death. A deficiency of cortisol produces many metabolic abnormalities, such as decreases in glucose production, protein and fat metabolism, appetite, and digestion. Serious systemic effects include a decrease in vascular tone and a diminished effect of catecholamines such as epinephrine and norepinephrine. Normally, a body under stress releases corticosteroids. Both the decrease in the vascular tone of the blood vessels and the decreased effect of catecholamines in an individual in an adrenal crisis can cause shock. The deficiency of aldosterone results in profound fluid and electrolyte imbalances: a decrease in sodium and water retention, a decrease in circulating blood volume, and an increase in both potassium and hydrogen ion reabsorption.