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Adrenal crisis is an endocrine emergency that can present with hypotension, vomiting, abdominal pain, hypoglycemia, hyponatremia or unexplained circulatory collapse. International guidance emphasizes immediate administration of parenteral hydrocortisone when adrenal crisis is suspected; treatment should not be delayed while waiting for confirmatory laboratory results. For internists, the most useful preventive strategy is identifying patients at risk, including those with known adrenal insufficiency, chronic glucocorticoid exposure and disorders affecting the hypothalamic-pituitary-adrenal axis. During severe illness, surgery or inability to take oral steroids, stress-dose management may be required. The clinical picture can overlap with sepsis and other causes of shock, so the two may need to be treated simultaneously while diagnostic evaluation proceeds. Patient education, emergency steroid supplies and clear sick-day rules reduce risk outside hospital. The key practical lesson is that adrenal crisis is a diagnosis where prompt treatment based on clinical suspicion is more important than diagnostic perfection at presentation.
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Adrenal crisis is an endocrine emergency that can present with hypotension, vomiting, abdominal pain, hypoglycemia, hyponatremia or unexplained circulatory collapse. International guidance emphasizes immediate administration of parenteral hydrocortisone when adrenal crisis is suspected; treatment should not be delayed while waiting for confirmatory laboratory results. For internists, the most useful preventive strategy is identifying patients at risk, including those with known adrenal insufficiency, chronic glucocorticoid exposure and disorders affecting the hypothalamic-pituitary-adrenal axis. During severe illness, surgery or inability to take oral steroids, stress-dose management may be required. The clinical picture can overlap with sepsis and other causes of shock, so the two may need to be treated simultaneously while diagnostic evaluation proceeds. Patient education, emergency steroid supplies and clear sick-day rules reduce risk outside hospital. The key practical lesson is that adrenal crisis is a diagnosis where prompt treatment based on clinical suspicion is more important than diagnostic perfection at presentation.
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