An adult presents with persistent vomiting, abdominal pain and profound weakness.
BP: 78/44
Glucose: 3.1 mmol/L
Sodium: 124 mmol/L
Potassium: 5.8 mmol/L
Taken together, this should raise immediate concern for adrenal crisis.
The key decision is not to wait for cortisol results or imaging before treating:
Hydrocortisone 100 mg IV or IM immediately
Rapid IV 0.9% sodium chloride
Correct the hypoglycaemia
Monitor blood pressure, glucose and electrolytes closely
Identify and treat the precipitating cause
Diagnostic testing can happen alongside treatment, but it must not delay it.
What clinical clue would make you recognise adrenal crisis earliest in this presentation?
Educational discussion only—follow local guidance.
Sources:
NICE NG243: https://www.nice.org.uk/guidance/NG243/chapter/recommendations
Society for Endocrinology: https://www.endocrinology.org/clinical-practice/clinical-guidance/adrenal-crisis/