Medicina 2002; 38 (7): 769-775

Clinic of Intensive Care, Kaunas University of Medicine, Lithuania

Key words: adrenal insufficiency, adrenal crisis, acute adrenocortical insuffiency.

Summary. Severe acute adrenocortical insufficiency or adrenal crisis are often elusive diagnoses that may result in severe mortabidity and mortality when undiagnosed or ineffectively treated. Although more than 50 steroids are produced within the adrenal cortex, cortisol and aldosterone are by far the most abundant and physiologically active. In primary adrenocortical insufficiency, glucocorticoid and mineralcorticoid properties are lost; however, in secondary adrenocortical insufficiency (ie, secondary to disease or suppression of the hypothalamic – pituitary axis), mineralocorticoid function is preserved. Every emergency physician should be familiar with adrenocortical insufficiency – a potentially life–threatening entity. The initial diagnosis and decision to treat are presumptive and are based on history, physical examination, and, accasionally, laboratory findings. Delay in treatment while attempting to confirm this diagnosis can result in poor patient outcomes. This article review data about physiology, pathophysiology of the adrenal cortex, physiologic effets of glucocorticoids, aldosterone, causes of primary and secondary adrenal insufficiency, frequency, clinical picture, laboratory and imaging studies of adrenal crisis, laboratory evaluation of adrenal function and emergency therapy, replacement therapy, mortality / morbidity of this pathology.

Correspondence to D.Reingardienė, Clinic of Intensive Care, Kaunas University of Medicine, Eivenių 2, 3007 Kaunas, Lithuania