Adrenal insufficiency

- Adrenal insufficiency should be on the differential if a patient has nonspecific symptoms, such as weakness, fatigue, nausea/vomiting, abdominal pain, confusion or presyncope

- Primary versus secondary? Primary adrenal insufficiency can have hyperkalemia, hyperpigmentation and more severe hypotension compared to a pituitary cause. Hyponatremia can actually be found in both - either from lack of mineralocorticoids (primary) or from SIADH (secondary)

- Treatment of an adrenal crisis is IV fluids and hydrocortisone 100 mg IV Q8H. If this is a new diagnosis then all labs should be drawn before steroids are given. If the patient is not acutely ill, a morning cortisol level and ACTH stim test are used to confirm the diagnosis

- Here is a review on adrenal insufficiency