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Introduction
Acute adrenal insufficiency, also termed adrenal a hormone important for blood pressure and electrolyte
Endocrine Connections
crisis, is a life-threatening endocrine emergency brought regulation. This puts primary adrenal insufficiency
about by a lack of production of the adrenal hormone patients at a somewhat higher risk of adrenal crisis.
cortisol, the major glucocorticoid. Identifying patients
at risk and prompt management can save lives. This
guideline aims to take the non-specialist through the
Clinical presentation
initial phase of assessment and management.
Clinical signs and symptoms:
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DOI: 10.1530/EC-16-0054 Published by Bioscientifica Ltd Attribution-NonCommercial-NoDerivatives 4.0
International License.
Emergency Guidance W Arlt and the Society Acute adrenal insufficiency G2G3 5:G2
for Endocrinology Clinical emergency guidance
Committee
http://www.endocrineconnections.org 2016 Society for Endocrinology This work is licensed under a Creative Commons
DOI: 10.1530/EC-16-0054 Published by Bioscientifica Ltd Attribution-NonCommercial-NoDerivatives 4.0
International License.
Emergency Guidance W Arlt and the Society Acute adrenal insufficiency G3G3 5:G3
for Endocrinology Clinical emergency guidance
Committee
or iv infusion during prolonged vomiting or times and showing it to any health care professional
diarrhoea, during preparation for colonoscopy they are dealing with
or in case of acute trauma or surgery requiring Provide them with emergency phone numbers and
general anaesthesia contact details for the patient self-help groups
Further information
After emergency care: how to prevent an For further information and to request a steroid card, please go to the
Society for Endocrinologys website www.endocrinology.org/adrenal-crisis.
adrenal crisis
dose for at least 7days 1 WassJA & ArltW. How to avoid precipitating an acute adrenal crisis.
Sick Day Rule 2: the need to administer British Medical Journal 2012 345 e6333. (doi:10.1136/bmj.e6333)
2 HusebyeES, AllolioB, ArltW, BadenhoopK, BensingS, BetterleC,
glucocorticoids per i.v. or i.m. injection during
FalorniA, GanEH, HultingAL, Kasperlik-ZaluskaA, etal. Consensus
prolonged vomiting or diarrhoea, during statement on the diagnosis, treatment and follow-up of patients with
preparation for colonoscopy or in case of acute primary adrenal insufficiency. Journal of Internal Medicine 2014 275
104115. (doi:10.1111/joim.12162)
trauma or surgery
3 HahnerS, SpinnlerC, FassnachtM, Burger-StrittS, LangK,
Teach the patient and partner/parents how to self- MilovanovicD, BeuschleinF, WillenbergHS, QuinklerM &
administer and inject hydrocortisone and provide AllolioB. High incidence of adrenal crisis in educated patients with
chronic adrenal insufficiency: a prospective study. Journal of Clinical
them with a Hydrocortisone Emergency
Endocrinology and Metabolism 2015 100 407416. (doi:10.1210/
Injection kit (100mg hydrocortisone sodium jc.2014-3191)
succinate for injection; hyperlink to ADSHG and 4 BancosI, HahnerS, TomlinsonJW & ArltW. Diagnosis and
management of adrenal insufficiency. Lancet Diabetes & Endocrinology
Pit foundation where there are picture tutorials
2015 3 216226.
on using this); check regularly that their kit is up 5 AllolioB. Extensive expertise in endocrinology: adrenal crisis.
to date European Journal of Endocrinology 2015 172 R115R124. (doi:10.1530/
eje-14-0824)
Provide the patient with a Steroid Emergency Card 6 BornsteinS, AllolioB, ArltW, BarthelA, Don-WauchopeA,
HammerGD, HusebyeE, MerkeDP, MuradMH, StratakisCA, etal.
www.endocrinology.org/adrenal-crisis and encourage
Management of primary adrenal insufficiency: an Endocrine Society
them to wear medical alert bracelets, in addition to clinical practice guideline. Journal of Clinical Endocrinology and
keeping the steroid emergency card with them at all Metabolism 2016 101 364389. (doi:10.1210/jc.2015-1710)
http://www.endocrineconnections.org 2016 Society for Endocrinology This work is licensed under a Creative Commons
DOI: 10.1530/EC-16-0054 Published by Bioscientifica Ltd Attribution-NonCommercial-NoDerivatives 4.0
International License.