Answer
Guidelines from Britain’s Society for Endocrinology on the emergency management of adrenal crisis, published in 2016, include the following diagnostic recommendations [16] :
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Adrenal insufficiency should be ruled out in any acutely ill patient with signs or symptoms potentially suggestive of acute adrenal insufficiency
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Assess blood pressure and fluid balance status; if clinically feasible, measure blood pressure from supine to standing to check for postural drop
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Assess patient drug history; determine whether there has been glucocorticoid use
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Perform appropriate blood tests: Sodium, potassium, urea, and creatinine; full blood counts; thyroid-stimulating hormone and free thyroxine; paired serum cortisol and plasma ACTH
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If the patient is hemodynamically stable, consider performing a short Synacthen test (serum cortisol at baseline and 30 min after intravenous injection of 250 μg ACTH 1–24)
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Serum/plasma aldosterone and plasma renin
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Diagnostic measures should never delay prompt treatment of a suspected adrenal crisis
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Regulation of the adrenal cortex.
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