title: Conduct protocol in emergency: Acute adrenal insufficiency.
abstract: Acute adrenal insufficiency or addisonian crisis is a rare comorbidity in emergency; however, if not properly diagnosed and treated, it may progress unfavorably.
  To alert all health professionals about the diagnosis and correct treatment of this complication.
  We performed an extensive search of the medical literature using specific search tools, retrieving 20 articles on the topic.
  Addisonian crisis is a difficult diagnosis due to the unspecificity of its signs and symptoms. Nevertheless, it can be suspected in patients who enter the emergency room with complaints of abdominal pain, hypotension unresponsive to volume or vasopressor agents, clouding, and torpor. This situation may be associated with symptoms suggestive of chronic adrenal insufficiency such as hyperpigmentation, salt craving, and association with autoimmune diseases such as vitiligo and Hashimoto's thyroiditis. Hemodynamically stable patients may undergo more accurate diagnostic methods to confirm or rule out addisonian crisis. Delay to perform diagnostic tests should be avoided, in any circumstances, and unstable patients should be immediately medicated with intravenous glucocorticoid, even before confirmatory tests.
  Acute adrenal insufficiency is a severe disease that is difficult to diagnose. It should be part of the differential diagnosis in cases of hypotensive patient who is unresponsive to vasoactive agents. Therefore, whenever this complication is considered, health professionals should aim specifically at this pathology.
authors.affiliation: Medical Student, 6th year, Faculdade de Medicina de São José do Rio Preto (Famerp), São José do Rio Preto, SP, Brazil.
authors.forename: Adil Bachir
authors.initials: AB
authors.lastname: Fares
authors.affiliation: Degree in Endocrinology and Metabology from Sociedade Brasileira de Endocrinologia e Metabologia (SBEM). Assistant Physician at the Internal Medicine Service of Hospital de Base. Researcher at Centro Integrado de Pesquisa (CIP), Hospital de Base, São José do Rio Preto. Endocrinology Coordinator of the Specialties Outpatient Clinic (AME), São José do Rio Preto, SP, Brazil.
authors.forename: Rômulo Augusto Dos
authors.initials: RA
authors.lastname: Santos
mesh_terms: D000208:Acute Disease; D000224:Addison Disease / Q000175:diagnosis / Q000628:therapy; D000309:Adrenal Insufficiency / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D002985:Clinical Protocols; D003937:Diagnosis, Differential; D004632:Emergency Medical Services / Q000592:standards*; D006801:Humans; D007022:Hypotension / Q000175:diagnosis / Q000628:therapy