Synopsis
Identify adrenal crisis clinically, deliver hydrocortisone and fluid resuscitation without delay, correct complications and convert recovery into a robust prevention plan.
- Think of crisis in unexplained hypotension or shock, especially with vomiting, abdominal pain, fever, confusion, hypoglycaemia, hyponatraemia, hyperkalaemia or a steroid history.
- The Society for Endocrinology states that suspected crisis should receive hydrocortisone without delay; short-term high-dose glucocorticoid is far safer than missing the diagnosis.
- Administer 100 mg hydrocortisone intravenously or intramuscularly immediately, then 200 mg over 24 hours by continuous infusion or 50 mg every six hours until clinical recovery and endocrine review.
Key red flags
Postural or persistent hypotension, tachycardia, cool peripheries, prolonged capillary refill, oliguria or shock may be prominent. Relative bradycardia does not exclude crisis when medicines or conduction disease are present.
Investigation priorities
Quantify immediate physiological threat and treat reversible hypoglycaemia.
Management branches
Compatible acute illness with hypotension, vomiting, altered consciousness or major adrenal risk.
- Call for senior help, start ABCDE monitoring, establish IV access and check bedside glucose; draw cortisol/ACTH and routine bloods only if instantly available.
- Give hydrocortisone 100 mg IV or IM immediately and begin rapid 0.9% sodium chloride, repeatedly reassessing perfusion, lungs, urine output and comorbidity.
Key medicines
Hydrocortisone emergency injection100 mg IV or IM immediately, followed by 200 mg over 24 hours or 50 mg IV or IM every six hours.
Sodium chloride 0.9% intravenous fluidGive rapid initial resuscitation, then individualise further volume and rate from haemodynamics, sodium trend, urine output, renal function and cardiac status.