Clinical Characteristics, Etiology, and Outcome of Patients with Adrenal Crisis: A Single-Center Experience

Background: Adrenal crisis is a life-threatening medical emergency associated with high mortality unless it is recognized early and treated. Aims: The aim of this study was to evaluate the clinical characteristics, etiology, and outcomes of patients with adrenal crisis. Methods: This was a hospital-based, prospective study of 35 adult patients, age >18 years diagnosed with the adrenal crisis. Patients were studied for clinical, etiological, laboratory parameters, comorbidities, and outcome. Results: The mean age of patients with the adrenal crisis was 47.2 ± 16.8 years, and there was female (68.6%) preponderance. The most common mode of presentation was hypotension (100%), shock (94.3%), altered sensorium (28.6%), hyponatremia (45.7%), hypoglycemia (17.1%), and sepsis (37.1%). Hypoglycemia and hyperlactatemia were predominantly found in patients without known adrenal insufficiency before the presentation. Secondary adrenal failure (57.1%) followed by sepsis-related adrenal failure (34.3%) and primary adrenal failure (8.1%) was the most common cause of admission. Secondary adrenal failure comprised of withdrawal of exogenous glucocorticoid therapy (25%), Sheehan syndrome (30%), pituitary surgery (15%), and pituitary tumor (15%). Overall mortality was 17.1%, with the highest mortality for sepsis-related adrenal failure (33.3%). Elderly (age >60 years), altered sensorium, serum sodium <120 mEq/L, hypoglycemia, multiorgan dysfunction syndrome (MODS), and lactic acidosis significantly increase the mortality in adrenal crisis. Conclusions: Patients with adrenal crisis carry significant morbidity and mortality with particular emphasis on sepsis-related adrenal failure. The factors predicting mortality in adrenal crisis are elderly, altered sensorium at presentation, severe hyponatremia, hypoglycemia, MODS, and lactic acidosis.