Adrenal crisis is an acute life threatening condition wherein there is a lack of cortisol.

With
increasing age and presence of comorbidity, risk of having adrenal insufficiency becomes higher.
However, many cases remained undiagnosed. In Primary Adrenal insufficiency all steroid hormones
synthesized by the adrenal grands (cortisol, aldosterone and sex steroids) are deficient and they are
more prone to experience adrenal crisis while in secondary adrenal insufficiency, only hormones
controlled by ACTH (cortisol and sex steroids) are deficient but they developed more severe adrenal
crisis. In addition, Cardiovascular disease is the leading cause of death in patients with Primary adrenal
insufficiency while for those with secondary adrenal insufficiency, higher percentage of patient who
experienced adrenal crisis and higher doses of hydrocortisone died. It is found out that the most
frequent precipitating cause of adrenal crisis are gastroenteritis, stress and fever. Medications such as
Carbamazepine, Mitotane, Rifampicin and St John’s worth increases cortisol clearance, it is important
that this effect is anticipated prior to initiation and an appropriate daily glucocorticoid dose is given.
Similar management of the disease in children and adult is employed however it varies in weight-based
dosing and difficulty in IV access. Emergency treatment includes immediate administration of parenteral
hydrocortisone via a bolus injection of intravenous or intramuscular hydrocortisone. Prompt rehydration
should be initiated with isotonic saline, a rapid IV infusion of 1 liter of isotonic saline within the first
hour. Patients may also require parenteral glucose therapy if hypoglycemic. It is important that
treatment should not be delayed. For the prevention, patient education is the most important to
prevent adrenal crisis. It should be reinforced to patients to administer a hydrocortisone emergency
injection and seek urgent medical care if they experience adrenal crisis. Patients should have access to a
vial of injectable hydrocortisone available at all times. The affected individual, their family members
should be trained in parenteral hydrocortisone administration. In conclusion, it is difficult to experience
adrenal crisis, one should be knowledgeable about this condition and be able to help individual
experiencing it. As a pharmacist, we should do of medication counselling, be knowledgeable in drug
interactions (drug-disease, drug-drug) and tell the patient how importance medication adherence and
understanding his/her disease.