Adrenal Insufficiency, Emergency Medicine

Rita K. Cydulka and Joseph P. Tagliaferro Reviewed 06/2017
 


Basics

Description

  • Inadequate hydrocortisone secretion to meet body's stress requirement

  • Adrenal deficiency:

    • Inadequate cortisol

    • Unresponsive to stimulation with adrenocorticotropic hormone (ACTH)

  • Function...

Diagnosis

Signs and Symptoms

  • Symptoms:

    • Depression

    • Weakness, tiredness, fatigue

    • Anorexia

    • Abdominal pain (can mimic acute abdomen)

    • Nausea or vomiting

    • Salt craving

    • Postural dizziness

    • Muscle or joint pains

    • Dehydrat...

Treatment

Initial Stabilization/Therapy

  • Airway, breathing, and circulation management (ABCs)

  • Cardiac monitor

  • BP support for hypotension:

    • Normal saline (0.9%) IV fluids 500 mL–1 L (peds: 20 mL/kg) bolus

    • Avo...

Follow-Up

Disposition

Admission Criteria

  • All patients with acute adrenal insufficiency

  • ICU admission for patients with unstable or potentially unstable cases

Discharge Criteria

  • Normal lab evaluation with t...

Pearls and Pitfalls

  • Acute adrenal insufficiency is a life-threatening emergency, and treatment should not be delayed in the ED while waiting for definite lab diagnosis.

  • Cancer of any type can present w...

Additional Reading

  • Bouillon  R. Acute adrenal insufficiency. Endocrinol Metab Clin N Am.  2006;35:767–775.

  • Kwon  KT, Tsai  VW. Metabolic emergencies. Emerg Med Clin N Am.  2007;25:1041–1060.

  • M...

Codes

ICD9

  • 255.41 Glucocorticoid deficiency

  • 255.5 Other adrenal hypofunction

ICD10

  • E27.1 Primary adrenocortical insufficiency

  • E27.2 Addisonian crisis

  • E27.40 Unspecified adrenocortical insufficiency

SNOMED

  • 386...

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