Consider acute adrenal insufficiency in patients with shock unresponsive to fluid resuscitation and vasopressors.
If untreated, primary adrenal insufficiency is always fatal.
The history is important and often includes non-specific symptoms such as unexplained weight loss, dizziness and fatigue.
Blood tests classically display hyponatraemia, hyperkalaemia and dehydration.
Diagnosis is with a random cortisol or short synacthen test
Immediate treatment is with steroid replacement and IV fluid resuscitation.
Patient education is important on discharge.
