Anesthetic and ICU Management of Patient with Adrenal Insufficiency

Abstract

SUMMARY AND CONCLUSION A ddison’s disease, also known as primary adrenal insufficiency and hypocortisolism, is a long-term endocrine disorder in which the adrenal glands do not produce enough steroid hormones. Addison's disease arises from problems with the adrenal gland such that not enough of the steroid hormone cortisol and possibly aldosterone are produced, most often due to damage by the body's own immune system in the developed world and tuberculosis in the developing world. Other causes include certain medications, sepsis, and bleeding into both adrenal glands. Secondary adrenal insufficiency is caused by not enough adrenocorticotropic hormone (ACTH) (produced by the pituitary gland) or CRH (produced by the hypothalamus). Despite this distinction, adrenal crises can happen in all forms of adrenal insufficiency. Addison's disease is generally diagnosed by blood tests, urine tests, and medical imaging (Adam et al., 2014). Anesthesia for adrenal insufficiency should not be taken lightly. There are multiple complications that may face the anesthiest in managing a case of adrenal insufficiency such as hypotension, hyperkalemia, dehydration, hypovolemia, metabolic acidosis and electrolyte disturbance. The conduct of anesthesia is dependent on whether the patient is controlled on treatment or not (Napier et al., 2014) Standard therapy involves intravenous injections of glucocorticoids and large volumes of intravenous saline solution with dextrose. This treatment usually brings rapid improvement. If intravenous access is not immediately available, intramuscular injection of glucocorticoids can be used. When the patient can take fluids and medications by mouth, the amount of glucocorticoids is decreased until a maintenance dose is reached. If aldosterone is deficient, maintenance therapy also includes oral doses of fludrocortisone acetate (Michels et al., 2014)