Adrenal insufficiency is an endocrine disorder that includes reduced levels of hormone secretion from the adrenal glands. These hormones include cortisol and aldosterone. Adrenal insufficiency may lead to an adrenal crisis which is a life-threatening
emergency caused by the adrenal glands inability to produce sufficient cortisol in response to major stress.
An adrenal crisis can be precipitated by a significant illness, trauma, stress, infection, and/or non-compliance with medications. An adrenal crisis usually takes several hours to develop but can occur more quickly. If left untreated, it can
Types of Adrenal Insufficiency:
Primary: Diseases of the adrenal gland eg. Addison’s Disease, Congenital Adrenal Hyperplasia, Adrenoleukodystrophy.
Secondary:Diseases of the pituitary gland or hypothalamus eg. Hypopituitarism, Craniopharyngiomas and head injuries.
Monitor patient persistently, recording full observations every 10 minutes (or 5 minutes if time critical)
Consider repeat BGL
Transport Priority 1 if patient time critical, pre-notifying receiving facility
Critical & Extended Care (CCP, PSO)
As per Advanced Care (AP) guidelines
St John WA has a database of patients who have known Primary Adrenal Insufficiency (Addison's Disease) and have communicated their needs to Clinical Services.
Notification of these patients will be provided via a Medical Warning displayed on the CAD with instructions to call the Clinical Support Paramedic in the State Operations Centre. In these cases, the CSP may authorise crews to administer the patients’ own hydrocortisone (known as Solu-cortef) if the patient is found to be experiencing an adrenal crisis.
A CSP may be tasked as an additional resource to known patients.
There is a subset of Addison's Disease patients' who are known as 'ultra-rapid metabolisers' of steroid medication, who may require up to 3 x the normal amount of hydrocortisone in adrenal crisis. Consider an ASMA consult if suspected.