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Adrenal insufficiency: recognition ⚠️ 🩺
For education and revision only. Check current NICE/BNF, specialist guidance and local NHS policy before clinical use. Newly added V19 material has not received independent clinical sign-off.
Primary or secondary adrenal insufficiency may be missed until physiological stress unmasks cortisol deficiency and precipitates adrenal crisis.
Recognise
- Chronic fatigue, weight loss, postural hypotension, abdominal symptoms, hyponatraemia; hyperkalaemia and pigmentation support primary adrenal failure but are not universal.
- Steroid withdrawal, pituitary disease, adrenal disease and acute illness can all precipitate problems.
Initial evaluation and safety
- If adrenal crisis is suspected, give emergency hydrocortisone and resuscitation immediately under local emergency protocol; do not delay treatment while awaiting cortisol tests.
- In stable suspected deficiency, use appropriately timed cortisol/ACTH and endocrine-led dynamic testing; consider medication and assay effects.
- Patients need a sick-day plan, emergency steroid awareness and specialist follow-up.
Clinical reasoning: Stress increases cortisol demand. A patient with borderline baseline reserve may become profoundly hypotensive during infection or surgery.
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