Integrated Emergency, Nursing, and Family Medicine Approaches to the Recognition and Management of Adrenal Crisis
Abstract
Background: Adrenal crisis is a life-threatening endocrine emergency caused by a severe deficiency of cortisol, often triggered by physiologic stress in individuals with underlying adrenal insufficiency. Despite being treatable, it carries a significant mortality rate, estimated at 0.5 deaths per 100 patient-years, primarily due to delays in recognition and intervention.
Aim: This article aims to outline the integrated, multidisciplinary approach required for the prompt recognition, emergency management, and long-term prevention of adrenal crisis, emphasizing roles across emergency medicine, nursing, and family medicine.
Methods: Management is centered on immediate parenteral glucocorticoid administration (100mg hydrocortisone IV/IM) and aggressive fluid resuscitation with isotonic saline. This is coupled with correction of hypoglycemia and electrolyte imbalances. Diagnosis relies on clinical suspicion based on a history of adrenal insufficiency, chronic steroid use, or presentation with refractory hypotension, and is supported by laboratory findings (e.g., hyponatremia, hyperkalemia, hypoglycemia).
Results: Prompt treatment leads to rapid clinical improvement, but delayed intervention results in high mortality and complications such as seizures, arrhythmias, and multi-organ failure. Patient education on "sick day rules" (stress-dose steroids) and access to emergency hydrocortisone injection kits are critical for preventing recurrent crises.
Conclusion: Adrenal crisis remains a preventable cause of death. Optimal outcomes depend on a high index of suspicion, immediate empiric therapy, and a coordinated interprofessional team strategy to ensure seamless care from emergency response to long-term community management.
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Copyright (c) 2025 Badrea Asri Alenazy, Khulud Saleh Ashamlani, Sultan Daaj Alotaibi, Khalid Abdullah Mudaysh Bajawi, Lawahith Mohammad Alhumaidan, Ahmed Saeed Alzahrani, Maryaim Yousef Alshehab, Khalid Mohammed D Aldossari, Zahra Ali Alzahrani, Aeshah Omar Musayyab Almaghrabi, Wejdan Hamed Saghir, Abeer Oudah Alyanbaawi, Rabab Ebrahim Qaboli
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