Acute Adrenocortical Insufficiency

Overview
  • Acute Adrenocortical Insufficiency refers to the clinical syndrome associated with a sudden deficiency in corticosteroids.
Etiologies
  • A variety of diverse etiologies can be source of Acute Adrenocortical Insufficiency. In patients with background chronic adrenocortical insufficiency a sudden increase stress such as caused the onset of acute infection or surgery can rapidly result in escalation of adrenocortical insufficiency into an acute pattern, referred to as "Adrenal Crisis". Massive, bilateral hemorrhage into adrenal glands resulting in their destruction may occur during contexts of DIC, anticoagulant administration, or fulminant Neisseria meningitides infection, termed Waterhouse-Friderichsen Syndrome. Sheehan Syndrome describes the sudden loss of ACTH secretion due to postpartum ischemic necrosis of the anterior pituitary following a catastrophically hemorrhagic delivery of a neonate.
  • Finally, rapid removal of pharmacological glucocorticoids such as dexamethasone or prednisone may precipitate acute adrenocortical insufficiency. This arises because long-term pharmacological glucocorticoid administration suppresses ACTH secretion, resulting in atrophy of the adrenal cortex, and thus leaving little endocrine tissue to replace previously exogenously administered glucocorticoids. Consequently, patients who have been on long-term glucocorticoid treatment must be slowly weaned off these drugs to allow sufficient time for functional recovery of their adrenal cortices.
Clinical Consequences
  • Acute Adrenocortical Insufficiency is characterized by nausea, vomiting, and abdominal pain. Patients exhibit progressive lethargy and somnolence due to insufficient cortisol levels. At late stages hypovolemic shock may ensue due to insufficient aldosterone levels.