Adrenal Insufficiency Assessment
Clinical and biochemical assessment for primary (Addison's disease) and secondary adrenal insufficiency, including adrenal crisis risk.
Score interpretation
Low clinical suspicion for adrenal insufficiency. Cortisol normal if measured.
→ Cortisol > 450 nmol/L at 9am excludes adrenal insufficiency in most clinical contexts. Consider alternative diagnoses for symptoms.
Possible adrenal insufficiency. Short Synacthen Test (SST) required.
→ Short Synacthen Test: 250 mcg tetracosactide IM/IV, cortisol at 0 and 30 min. Normal response: cortisol ≥ 500 nmol/L at 30 min. If abnormal: refer endocrinology. Check ACTH (elevated = primary; low = secondary). DHEAS, aldosterone, renin if primary suspected. 21-hydroxylase antibodies (autoimmune Addison's). CT adrenals if primary.
Adrenal crisis suspected. Life-threatening without immediate treatment.
→ IMMEDIATE IV hydrocortisone 100mg bolus (NO need to wait for cortisol results). IV fluid resuscitation: 1L 0.9% NaCl stat (may need glucose if hypoglycaemia). Treat precipitant (infection is most common cause — broad-spectrum IV antibiotics). Continue hydrocortisone 50–100mg IV/IM 6-hourly. Monitor U&E, glucose. Once stable: switch to oral hydrocortisone 10mg/5mg/5mg taper. Sick-day rules education. MedicAlert bracelet. Emergency hydrocortisone injection kit for self-administration.
Interpretation bands for the Adrenal Insufficiency. Apply clinical judgement and local guidance.
References
- Bornstein SR et al. Diagnosis and Treatment of Primary Adrenal Insufficiency: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2016.
- NICE NG247. Addison's disease. 2023.
Related
Curated clinical cross-links plus same-class fallbacks.
- Hydrocortisone (IV — Paediatric Emergency) · IV Corticosteroid / Adrenal Replacement
- Hydrocortisone (ICU — Stress Dosing) · Corticosteroid (ICU/Septic Shock)
- Hydrocortisone (Topical) · Mild Topical Corticosteroid
- Clotrimazole · Topical / vaginal imidazole antifungal
- Hydrocortisone butyrate · Potent topical corticosteroid
- Hydrocortisone with chlorhexidine and nystatin · Topical mild steroid + antibacterial + antifungal
- Diabetic Ketoacidosis (DKA) · JBDS 2013 / Joint British Diabetes Societies; NICE NG17
- Adult Hypoglycaemia (Treated Diabetes) · JBDS-IP (2023): Hospital Management of Hypoglycaemia
- Adrenal Crisis · Society for Endocrinology Emergency Guidance (2024)
- Type 2 Diabetes Management · NICE NG28 2022
- Hyperthyroidism Management · BTA / ETA 2018
- Adrenal Insufficiency · Society of Endocrinology / ESE 2016
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.