Can Addisonian crisis cause a patient (pt) to be febrile (feverish)?

Fever in Addisonian Crisis

Yes, Addisonian crisis (adrenal crisis) can cause a patient to be febrile. Fever is recognized as one of the clinical manifestations of adrenal crisis and is specifically listed among the non-infectious inflammatory states that can cause fever in critically ill patients 1.

Clinical Presentation of Addisonian Crisis

Addisonian crisis is an acute life-threatening complication of adrenal insufficiency that requires immediate intervention. The clinical presentation typically includes:

• Fever
• Hypotension (often severe and refractory to fluids)
• Weakness and fatigue
• Nausea and vomiting
• Abdominal pain
• Confusion or altered mental status
• Hypoglycemia
• Electrolyte abnormalities (hyponatremia, hyperkalemia in primary adrenal insufficiency)

The presence of fever in Addisonian crisis is well-documented in the medical literature 2, 3. In fact, fever can be a prominent feature that may lead clinicians to initially suspect infection rather than adrenal insufficiency as the primary diagnosis.

Pathophysiology of Fever in Adrenal Crisis

The fever in Addisonian crisis is related to:

• Dysregulation of inflammatory responses due to cortisol deficiency
• Impaired stress response capacity 4
• Altered metabolism and reduced effective volemia 4
• Cardiovascular dysfunction with impaired perfusion 4

Diagnostic Considerations

It's important to note that fever in the context of adrenal insufficiency can create diagnostic challenges:

• The presentation may mimic sepsis, leading to delayed diagnosis of adrenal crisis 3
• Fever is included in the differential diagnosis for non-infectious inflammatory states in critically ill patients 1
• The symptoms can develop rapidly, within hours, even in previously stable patients 2

Management Implications

When a patient presents with fever and there is suspicion of Addisonian crisis:

1. Immediate administration of hydrocortisone 100 mg IV bolus is essential 4, 2
2. Follow with continuous infusion of 200-300 mg/day or divided doses every 6 hours 4
3. Rapid IV administration of isotonic saline for volume resuscitation 4
4. Regular blood glucose monitoring 4
5. Identify and treat any precipitating factors (infections, stress, trauma)

Common Pitfalls to Avoid

• Mistaking adrenal crisis for sepsis due to the presence of fever, leading to delayed glucocorticoid administration 3
• Inadequate stress dosing during illness or procedures 4
• Failure to recognize adrenal crisis promptly 4
• Insufficient patient education about emergency management 4
• Inappropriate glucocorticoid dosing leading to under-replacement 4

Prevention Strategies

For patients with known adrenal insufficiency:

• Patient education on stress dosing during illness (including febrile illnesses)
• Emergency preparedness with injectable hydrocortisone
• Medical alert bracelet/card
• Regular follow-up to assess replacement adequacy 4
• Training patients, relatives, and healthcare providers on early recognition of adrenal crisis 2, 5

In summary, fever is a recognized clinical feature of Addisonian crisis that can contribute to diagnostic challenges. Prompt recognition and immediate treatment with high-dose glucocorticoids are essential to prevent potentially fatal outcomes.