What are the Society for Endocrinology’s diagnostic recommendations for adrenal crisis?

Updated: Oct 11, 2018
  • Author: Kevin M Klauer, DO, EJD, FACEP; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Answer

Guidelines from Britain’s Society for Endocrinology on the emergency management of adrenal crisis, published in 2016, include the following diagnostic recommendations [15] :

  • Adrenal insufficiency should be ruled out in any acutely ill patient with signs or symptoms potentially suggestive of acute adrenal insufficiency
  • Assess blood pressure and fluid balance status; if clinically feasible, measure blood pressure from supine to standing to check for postural drop
  • Assess patient drug history; determine whether there has been glucocorticoid use
  • Perform appropriate blood tests: Sodium, potassium, urea, and creatinine; full blood counts; thyroid-stimulating hormone and free thyroxine; paired serum cortisol and plasma ACTH
  • 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)
  • Serum/plasma aldosterone and plasma renin
  • Diagnostic measures should never delay prompt treatment of a suspected adrenal crisis

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