Acute, severe glucocorticoid deficiency caused by either stress in a patient with underlying adrenal insufficiency or sudden discontinuation of glucocorticoids after prolonged glucocorticoid therapy

Clinical features

• Stress - infection, trauma, surgery
• Vomiting
• Abdominal pain
• Hypotension
• Shock

Management

• Rehydration - rapid bolus then fluid replacement of 0.9% sodium chloride
• Steroids - 100mg hydrocortisone IV injection, followed by 24hr hour hydrocortisone IV infusion or IM hydrocortisone injection every 6 hours
• Manage underlying cause/precipitant
• If in doubt treat as won't do any harm if incorrect diagnosis but can be life-threatening