- 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 be fatal.
- 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.
- Iatrogenic: Chronic corticosteroid treatment, Crohn’s Disease, Juvenile arthritis, Asthma, Nephrotic syndrome, haemangiomas.
- Commonly known diseases relating to adrenal insufficiency are Addison’s Disease, Congenital Adrenal Hyperplasia, Hypopituitarism, and Craniopharyngiomas.
- Hydrocortisone is life saving, do not unreasonably delay administration - IM and IV are equally as effective.
Known adrenal insufficiency presenting with any of the following signs and symptoms:
- Nausea, vomiting & diarrhoea
- Mottled appearance, peripheral shutdown
- Abdominal pain, weakness
- Low blood pressure, postural hypotension
- High fever
- Hypoglycaemia
- Lethargy, pallor
- Dizziness, mental confusion/loss of consciousness
- Rapid heart rate
- Monitor for signs of hypovolaemic shock, cardiac arrest, stroke or cardiac dysrhythmia.
- Hypoglycaemia may present pre- or post-administration of Hydrocortisone; manage as per guideline.
- Consider patient may present with Hyperkalaemia and/or Hyponaetremia.
- Rarely, adrenal insufficiency patients may present with psychosis in an acute crisis – history taking is important.
- Primary Survey
- Complete Vital Sign Survey
- Monitor closely GCS, HR, SpO2, BP, Temp and BGL
- Consider Oxygen as per CPG
- Consider oral glucose gel as per medication protocol if hypoglycaemic
- Apply cardiac monitor if trained and authorised
- Monitor patient persistently, recording full observations every 10 minutes (or 5 minutes if time critical)
- Repeat BGL at regular intervals
- Transport priority 1 if patient time critical, pre-notifying receiving facility
- Administer Hydrocortisone as per medication protocol. IM and IV both equally effective.
- Apply cardiac monitoring with 12 lead ECG
- Establish vascular access
- Consider obtaining prehospital blood sample
- Consider fluid therapy as per medication protocol
- Consider Oral Glucose, IV Glucose or Glucagon as per medication protocols
- Consider analgesia if required
- Monitor patient persistently, recording full observations every 10 minutes (or 5 minutes if time critical)
- Repeat BGL at regular intervals
- Transport Priority 1 if patient time critical, pre-notifying receiving facility
- As per Advanced Care 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.
| Settings | |
|---|---|
| Extended Care: | |
| Colour assist: | |
Document Control
Clinical Resources Website
St John Ambulance Western Australia Ltd (ABN 55 028 468 715) (St John WA) operates ambulance and other pre-hospital clinical services. St John WA’s Clinical Resources, including its Clinical Practice Guidelines (Clinical Resources), are intended for use by credentialed St John WA staff and volunteers when providing clinical care to patients for or on behalf of St John WA, within the St John WA Clinical Governance Framework, and only to the extent of the clinician’s authority to practice.
Other users – Terms of Use
The content of the St John WA Clinical Resources is provided for information purposes only and is not intended to serve as health, medical or treatment advice. Any user of this website agrees to be bound by these Terms of Use in their use of the Clinical Resources.
St John WA does not represent or warrant (whether express, implied, statutory, or otherwise) that the content of the Clinical Resources is accurate, reliable, up-to-date, complete or that the information contained is suitable for your needs or for any particular purpose. You are responsible for assessing whether the information is accurate, reliable, up-to-date, authentic, relevant, or complete and where appropriate, seek independent professional advice.
St John WA expressly prohibits use of these Clinical Resources to guide clinical care of patients by organisations external to St John WA, except where these organisations have been directly engaged by St John WA to provide services. Any use of the Clinical Resources, with St John WA approval, must attribute St John WA as the creator of the Clinical Resources and include the copyright notice and (where reasonably practicable) provide a URL/hyperlink to the St John WA Clinical Resources website.
No permission or licence is granted to reproduce, make commercial use of, adapt, modify or create derivative works from these Clinical Resources. For permissions beyond the scope of these Terms of Use, including a commercial licence, please contact medservices@stjohnambulance.com.au
Where links are provided to resources on external websites, St John WA:
- Gives no assurances about the quality, accuracy or relevance of material on any linked site;
- Accepts no legal responsibility regarding the accuracy and reliability of external material; and
- Does not endorse any material, associated organisation, product or service on other sites.
Your use of any external website is governed by the terms of that website, including any authorisation, requirement or licence for use of the material on that website.
To the maximum extent permitted by law, St John WA excludes liability (including liability in negligence) for any direct, special, indirect, incidental, consequential, punitive, exemplary or other loss, cost, damage or expense arising out of, or in connection with, use or reliance on the Clinical Resources (including without limitation any interference with or damage to a user’s computer, device, software or data occurring in connection with such use).
Cookies
Please read this cookie policy carefully before using Clinical Resources from St John WA.
The cookies used on this site are small and completely anonymous pieces of information and are stored on your computer or mobile device. The data that the cookies contain identify your user preferences (such as your preferred text size, scope / skill level preference and Colour Assist mode, among other user settings) so that they can be recalled the next time that you visit a page within Clinical Resources. These cookies are necessary to offer you the best and most efficient possible experience when accessing and navigating through our website and using its features. These cookies do not collect or send analytical information back to St John WA.
Clinical Resources does integrate with Google Analytics and any cookies associated with this service enable us (and third-party services) to collect aggregated data for statistical purposes on how our visitors use this website. These cookies do not contain personal information such as names and email addresses and are used to help us improve your user experience of the website.
If you want to restrict or block the cookies that are set by our website, you can do so through your browser setting. Alternatively, you can visit www.internetcookies.com, which contains comprehensive information on how to do this on a wide variety of browsers and devices. You will find general information about cookies and details on how to delete cookies from your device. If you have any questions about this policy or our use of cookies, please contact us.