Main symptoms are gastrointestinal symptoms and symptoms of shock (e.g. hypotension and confusion)
Lab findings:
Hypoglycaemia
Hyponatraemia
Hyperkalaemia
Hypercalcaemia
Increased urea and creatinine
Usually occurs in patients with primary adrenal insufficiency and precipitated by stress {e.g. illness or surgery) or abrupt cessation of glucocorticoid therapy
In patients with hypopituitarism, acute cortisol deficiency can occur but shock is less likely because of intact RAAS
Management
Collect blood samples for plasma glucose and electrolyte concentrations before starting treatment
If no prior history of primary adrenal insufficiency also collect plasma cortisol, ACTH and renin concentrations prior to treatment
For adults start with:
Hydrocortisone 100mg IV initially then 50 mg IV every 5 hours until stable and tolerating oral intake
Correct hypovolaemia as normal with normal saline
Correct hypoglycaemica
Hyperkalaemia usually responds to IV fluids and hydrocortisone; insulin dextrose infusion not commonly used