Treatment of Acute Adrenal Insufficiency

Hypoadrenocorticism is caused by a lack of endogenous glucocorticoid and mineralocorticoid. These deficiencies can cause a myriad of clinical signs. This disease is uncommon and its clinical presentation is similar to many much more commonly recognized diseases such as renal failure and various gastrointestinal disorders. Severely affected patients may present in a life-threatening adrenocortical crisis, which is characterized by variable degrees of volume depletion and electrolyte abnormalities. The emergency clinician should maintain a high clinical suspicion for hypoadrenocorticism, as early recognition and rapid treatment of hypovolemia and electrolyte abnormalities can be lifesaving. The approach to emergency treatment of hypoadrenocorticism should be to recognize and treat life-threatening arrhythmias, replace intravascular volume and normalize perfusion, correct electrolyte abnormalities and hypoglycemia, administer glucocorticoids, and perform the adrenocorticotrophic hormone stimulation test for definitive diagnosis. Patients with this condition should have a favorable outcome when treated appropriately.