Adrenal insufficiency: a review

Endocrine emergencies are commonly encountered by both primary care and prehospital clinicians, with diabetic presentations such as hypoglycaemia or hyperglycaemia considered routine (Savage et al, 2004). While most clinicians will feel comfortable in managing a diabetic emergency, other endocrine emergencies are more complex to manage because of both the rarity of presentations and a lack of reliable diagnostic and management tools available in the prehospital setting (Savage et al, 2004).

Of relevance to paramedic practice is that adrenal crisis is one of the two endocrine emergencies in which a patient may be pharmacologically stabilised under the UK ambulance services clinical practice guidelines (Association of Ambulance Chief Executives (AACE), 2019).

The mortality rate of established episodes of adrenal crisis is approximately 0.5–2%; however deaths are often preventable, and occur in relatively young patients because of delayed or insufficient steroid replacement (Amrein et al, 2018).