Hypoglycemia (reduced level of blood glucose)
Hyponatremia (low sodium level in the blood)
Hypotension (low blood pressure)
Hypothyroidism (low T4 level)
Severe vomiting and diarrhea, resulting in dehydration
Syncope (transient loss of consciousness) and/or orthostatic hypotension (drop in blood pressure on standing, leading to loss of balance)

Causes
Adrenal crisis is caused by a deficiency of cortisol resulting from Addisons disease, congenital adrenal hyperplasia (CAH), corticosteroid biosynthetic enzyme defects or pituitary disorders (such as Sheehans syndrome, pituitary adenoma, hypopituitarism (inactive or underactive pituitary) causing failure to activate the adrenal glands. May also be a side effect of Zytiga (Abiraterone) for prostate cancer. Diagnosis
Various investigations aid the diagnosis:
ACTH (cosyntropin) stimulation test
Cortisol level (to assess the level of glucocorticoids)
Fasting blood sugar
Serum potassium (to assess the level of mineralocorticoids)
Serum sodium

Prevention
Adrenal crisis is triggered by physiological stress (such as trauma) or severe psychological stress. Activities that have an elevated risk of trauma are best avoided. Treatment must be given within two hours of trauma and consequently it is advisable to carry injectable hydrocortisone in remote areas. Treatment
Acute adrenal insufficiency is a medical emergency and needs to be treated with injectable hydrocortisone and fluid support. 1L of 0.9% saline over 30-60 min with 100 mg of i.v. Bolus hydrocortisone. Continuous infusion of saline within 24hours with 100 mg I.m. hydrocortisone 6-hourly. Glucose
To be shifted to oral medication based on the patients state. Hydrocortisone 20 mg 8-hourly reduced to 20–30 mg in divided doses over few days. Fludrocortisone is given later. Epidemiology
Hahner et al.
Fibroma of tendon sheath is a benign tumor that presents as a small subcutaneous nodule that slowly increases in size. The tumors often have a multinodular growth pattern, with individual nodules being composed of bland, slender, spindle-shaped cells (myofibroblasts) in a dense, fibrous matrix.” A common microscopic finding is the presence of elongated, slit-like blood vessels. The lesions nearly always arise in the distal portions of the extremities. They often occur on the fingers, hands, toes, or feet. Although they are benign, they may recur in up to 40% of cases.Although they may be regarded as a tumor of the skin, the lesions arise from tendons and aponeuroses in superficial sites, and are therefore properly classified as in the category "soft tissue tumor." The World Health Organization, 2020, reclassified these tumors as a specific, benign tumor type in a broad category of soft tissue neoplasms termed fibroblastic and myofibroblastic tumors.The biological nature of Fibroma of tendon sheath is not known, but the category appears to comprise a number of different pathologic processes. It is considered that about one-third of the lesions in this category may be acral variants of the entity, nodular fasciitis. See also
Giant cell tumor of the tendon sheath
List of cutaneous conditions


== References ==