Abstract
Background
Adrenal insufficiency can result in significant patient morbidity and mortality, but
due to the range of symptoms and variable clinical course and etiologies, it can be
a challenging condition to diagnose and manage.
Objective
This narrative review will discuss the evaluation of an adult patient at risk for
a new diagnosis of adrenal insufficiency and the management of a patient with known
or suspected adrenal insufficiency.
Discussion
A new presentation of adrenal insufficiency can range from nonspecific, minor symptoms
including fatigue, to a life-threatening adrenal crisis with hemodynamic instability.
Due to the variety of signs and symptoms, the diagnosis is often missed. Those with
known adrenal insufficiency are at risk for adrenal crisis, which may occur due to
a variety of triggers. Initial evaluation includes assessment for the underlying etiology
or concomitant condition, laboratory analysis, and imaging, when clinically indicated.
Although not necessary for evaluation in the emergency department setting, the diagnosis
is confirmed by specific testing such as the cosyntropin stimulation test. The mainstay
of treatment in adrenal crisis is hydrocortisone, intravenous fluid, glucose repletion,
and treatment of the underlying acute trigger.
Conclusions
Emergency clinicians must be prepared to recognize, evaluate, and manage those with
known or suspected adrenal insufficiency or adrenal crisis.
Keywords
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Article info
Publication history
Published online: June 07, 2022
Accepted:
June 4,
2022
Received in revised form:
May 24,
2022
Received:
March 1,
2022
Footnotes
This review does not reflect the views or opinions of the U.S. government, Department of Defense, U.S. Army, U.S. Air Force, or SAUSHEC EM Residency Program.
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