SOCIETY FOR ENDOCRINOLOGY ENDOCRINE EMERGENCY GUIDANCE: Emergency management of acute adrenal insufficiency (adrenal crisis) in adult patients

Primary adrenal insufficiency is caused by loss of function of the adrenal gland itself, for example due to autoimmune-mediated destruction of adrenocortical tissue or surgical removal of the adrenal glands or due to inborn disruption of adrenal cortisol production in congenital adrenal hyperplasia. Secondary adrenal insufficiency is caused if the regulation of adrenal cortisol production by the pituitary is compromised, this can be the consequence of tumours in the hypothalamic–pituitary area. However, pituitary regulation of cortisol production is also switched off in patients who receive chronic exogenous glucocorticoid treatment with doses ≥5 mg prednisolone equivalent for more than 4 weeks. This may also be caused by long-lasting glucocorticoid injections into joints or chronic application of glucocorticoid cream or inhalers. In primary adrenal insufficiency cortisol deficiency is aggravated by a lack of adrenal aldosterone production, a hormone important for blood pressure and electrolyte regulation. This puts primary adrenal insufficiency patients at a somewhat higher risk of adrenal crisis.