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Adrenalitis – Severe

Assessment and Investigations

Adrenal crisis, rule out sepsis
Adrenalitis Unlikely
  • Random cortisol >160 µg/L
Likely
  • Random cortisol <160 µg/L

Management

  • Urgent hydrocortisone stress dose of hydrocortisone 100mg IV (or IM)
  • Intravenous hydration
  • Hold ICPI
  • Taper to physiological substitution in consultation with Endocrinology
  • Measure renin-aldosterone and start fludrocortisone in consultation with Endocrinology
  • Restart ICPI once adequately substituted