Adrenal crisis in adrenal insufficiency

(NEJM 2019;381;852)

• Precipitants: preexisting adrenal insufficiency + serious infection or GI illness, bilateral adrenal hemorrhage or infarction, pituitary infarction
• Presentation: shock + anorexia, N/V, abd pain, weakness, fatigue, confusion, coma, fever
• Lab findings: hyponatremia, hyperkalemia (1°)
• Rx: hydrocortisone 100 mg IV followed by 50 mg IV q6 + IVF; do not delay for dx tests