Clinical settings of adrenal crisis
1. In chronic primary adrenal insufficiency, when patients experience serious infection or other acute major stress. Adrenal crisis may be the initial presentation in a previously undiagnosed patient, in whom the stressor appears to tip the balance to frank hypotension.
2. It may also occur in patients with known primary or secondary adrenal insufficiency who are under-replaced, either because of: 1) insufficient daily doses of glucocorticoid and/or mineralocorticoid; 2) failure to take more glucocorticoid during an infection or other major illness; or 3) persistent vomiting or diarrhea caused by viral gastroenteritis or other gastrointestinal disorders, leading to decreased absorption.
3. An acute cause of adrenal gland destruction, such as bilateral infarction or hemorrhage, may precipitate adrenal crisis.
4. Development of an acute cause of secondary or tertiary adrenal insufficiency, such as pituitary infarction.
5. Unmasking of secondary adrenal insufficiency in patients who are abruptly withdrawn from supraphysiologic doses of glucocorticoid. Importantly, this includes not only oral but inhaled medications, and any formulation having systemic absorption.
REF. UpToDate 2020.07.07
