Adrenal Insufficiency

In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the October 2025 Emergency Medicine Practice article, Emergency Department Evaluation and Management of Patients With Adrenal Insufficiency

Introduction

• Welcome and host introductions
• Brief overview of the episode’s topic
• Resources and CME reminder

Article Overview

• Source: Emergency Medicine Practice, October 2025
• Authors: The Simcoes
• Importance of evidence-based review

Clinical Context & Epidemiology

• Frequency and rarity of adrenal insufficiency
• Diagnostic challenges and statistics
• Importance of recognizing adrenal crisis

Pathophysiology

• Primary, secondary, and tertiary adrenal insufficiency
• Causes and mechanisms
• Key anatomical and physiological concepts

Differential Diagnosis

• Overlap with other diseases (infections, autoimmune, endocrine, psychiatric, cardiac, GI, etc.)
• Importance of considering adrenal crisis in complex cases

Prehospital Care

• EMS recognition and limitations
• Importance of medication history and emergency kits
• Legal and logistical barriers to prehospital hydrocortisone

Emergency Department Evaluation

• Recognizing symptoms and prioritizing care
• Role of EMR and clinical decision support
• Key history and risk factors (medications, steroid use, opioid use, comorbidities)

Physical Examination

• Specific and nonspecific findings
• Cushingoid features vs. primary adrenal insufficiency signs

Diagnostic Workup

• Laboratory studies (cortisol, ACTH, renin, aldosterone, TSH, etc.)
• Imaging considerations
• Gold standard tests and their limitations in the ED

Treatment

• Immediate administration of hydrocortisone
• Dosing for adults and pediatrics
• Supportive care (fluids, glucose, treating underlying cause)
• Sick day dosing and home management

Special Populations

• Pregnancy considerations
• Septic shock and adrenal crisis

Common Pitfalls & Takeaways

• Delaying steroids for labs/diagnosis
• Importance of high suspicion and early treatment
• Key trivia and learning points

ClosingSummary and final thoughts

• Reminders for further reading and CME
• Farewell and next episode teaser

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