Sepsis minus a source? ADDrenal?

Adrenal Crisis Loss of mineralocorticoid and/or glucocorticoid production. Dysfunction is at level of pituitary (secondary or tertiary cause) or the adrenals (primary) with multiple causes:

  • autoimmune

  • suppression from exogenous hormone use

  • hemorrhage

  • tumor

  • infection

Clinical picture:

  • abdominal pain

  • vomiting

  • diarrhea

  • hypotension

  • refractory shock

  • fever

  • confusion

Chronic insufficiency will also give: weight loss, fatigue, arthralgia, myalgia, anorexia, mood change, syncope history, salt cravings, hyper pigmentation, vitiligo

Fever, shock, and confusion sounds like septic shock can labs help?

**for adrenal crisis a random cortisol level below 3 μg/dl (80 mmol/L) is diagnostic but will not be low in all cases

other labs you can expect to find, hypoglycemia, hyponatremia, hyperkalemia, elevated BUN creatinine, hypo-osmolarity


  • supportive measures

  • stress dose steroid hydrocortisone 100mg IV Q6

Bottom line -in your patients with refractory shock send cortisol level and give stress dose steroid

-consider this diagnosis in patients with autoimmune history, recently postpartum, chronic steroids, Sepsis with no source,