emDOCs.net Emergency Medicine (EM) Podcast Episode 55: Adrenal Insufficiency
Jun 7, 2022
Skyler Lentz, an emergency and critical care physician specializing in endocrine emergencies, joins to discuss adrenal insufficiency. He outlines cortisol physiology and contrasts acute crisis with chronic disease. He reviews triggers, key clinical signs, labs and when to give empiric hydrocortisone. Practical management and sick-day rules for patients are highlighted.
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Adrenal Insufficiency Comes From Any HPA Axis Failure
- Adrenal insufficiency arises from failure anywhere along the HPA axis causing inadequate cortisol during stress.
- Primary is adrenal failure; secondary is pituitary/hypothalamic failure often from tumors, radiation, or exogenous steroids.
Acute Crisis Is Often Missed Despite High Mortality
- Acute adrenal insufficiency is harder to recognize than chronic because patients lack a prior diagnosis and present nonspecifically.
- Adrenal crisis mortality is 6–15%, and 60% of cases need multiple evaluations before diagnosis.
Always Ask About Steroid Use And Autoimmune Risk
- Ask about autoimmune disease, TB, adrenal hemorrhage, malignancy, surgery, and any steroid use including inhaled forms.
- Remember inhaled steroids can suppress adrenals; asthmatics on inhaled steroids have ~5% risk.