title: Acute adrenal insufficiency: an aide-memoire of the critical importance of its recognition and prevention.
abstract: Adrenal crisis is a life-threatening emergency that causes significant excess mortality in patients with adrenal insufficiency. Delayed recognition by medical staff of an impending adrenal crisis and failure to give timely hydrocortisone therapy within the emergency department continue to be commonly encountered, even in metropolitan teaching hospitals. Within the authors' institutions, several cases of poorly handled adrenal crises have occurred over the last 2 years. Anecdotal accounts from members of the Addison's support group suggest that these issues are common in Australia. This manuscript is a timely reminder for clinical staff on the critical importance of the recognition, treatment and prevention of adrenal crisis. The manuscript: (i) outlines a case and the clinical outcome of sub-optimally managed adrenal crisis, (ii) summarises the clinical features and acute management of adrenal crisis, (iii) provides recommendations on the prevention of adrenal crisis and (iv) provides guidance on the management of 'sick days' in patients with adrenal insufficiency.
authors.affiliation: Department of Endocrinology, Royal Prince Alfred Hospital, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Gargya
authors.affiliation: Department of Endocrinology, Royal Prince Alfred Hospital, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: E
authors.initials: E
authors.lastname: Chua
authors.affiliation: Department of Endocrinology, Royal Prince Alfred Hospital, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Hetherington
authors.affiliation: Department of Endocrinology, Concord Hospital, Sydney, New South Wales, Australia.
authors.forename: K
authors.initials: K
authors.lastname: Sommer
authors.affiliation: Department of Endocrinology, Concord Hospital, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Cooper
mesh_terms: D000309:Adrenal Insufficiency / Q000097:blood / Q000175:diagnosis* / Q000517:prevention & control*; D002983:Clinical Competence / Q000592:standards*; D019468:Disease Management; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008875:Middle Aged
keywords: Addison's disease; adrenal crisis; adrenal insufficiency; corticosteroids