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Endocrinology Adrenal Emergencies Intermediate
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Primary Hypoadrenalism: Addisonian Crisis

5
S's
OF
ADRENAL
CRISIS
Life-threatening acute glucocorticoid and mineralocorticoid deficiency triggered by stress, infection, or abrupt steroid withdrawal.

Severe acute deficiency of cortisol and aldosterone impairs vascular tone, cardiac contractility, and renal conservation of sodium, precipitating refractory distributive and hypovolemic shock.

Systematic Breakdown

S

Salt (Severe Hyponatremia)

Mineralocorticoid deficiency causes renal sodium wasting and volume depletion.

S

Sugar (Hypoglycemia)

Cortisol deficiency diminishes hepatic gluconeogenesis and glycogenolysis.

S

Shock (Refractory Hypotension)

Severe vasodilation resistant to IV fluids and vasopressors until glucocorticoids are replaced.

S

Storm (Stomach / Abdominal Pain)

Acute abdominal pain, vomiting, and diarrhea frequently mimicking an acute surgical abdomen.

S

Steroids (Immediate IV Hydrocortisone)

Immediate administration of IV Hydrocortisone 100 mg bolus every 8 hours.

High-Yield Clinical Pearls & Exam Tips
  • Electrolyte hallmark: Hyponatremia + Hyperkalemia + Non-gap metabolic acidosis (due to aldosterone deficiency).
  • Do NOT delay treatment for ACTH stimulation test results in suspected crisis; Hydrocortisone can be substituted with Dexamethasone if cortisol assay is drawn concurrently.
Related Pharmaceuticals
Hydrocortisone Fludrocortisone Dexamethasone 0.9% Normal Saline
Related Clinical Conditions
Addison Disease Waterhouse-Friderichsen Syndrome Adrenal Insufficiency
Authoritative Sources: Endocrine Society Clinical Practice Guideline on Adrenal Insufficiency · First Aid USMLE Step 1

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