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 InsufficiencyIntroductionWelcome and host introductionsBrief overview of the episode’s topicResources and CME reminderArticle OverviewSource: Emergency Medicine Practice, October 2025Authors: The SimcoesImportance of evidence-based reviewClinical Context & EpidemiologyFrequency and rarity of adrenal insufficiencyDiagnostic challenges and statisticsImportance of recognizing adrenal crisisPathophysiologyPrimary, secondary, and tertiary adrenal insufficiencyCauses and mechanismsKey anatomical and physiological conceptsDifferential DiagnosisOverlap with other diseases (infections, autoimmune, endocrine, psychiatric, cardiac, GI, etc.)Importance of considering adrenal crisis in complex casesPrehospital CareEMS recognition and limitationsImportance of medication history and emergency kitsLegal and logistical barriers to prehospital hydrocortisoneEmergency Department EvaluationRecognizing symptoms and prioritizing careRole of EMR and clinical decision supportKey history and risk factors (medications, steroid use, opioid use, comorbidities)Physical ExaminationSpecific and nonspecific findingsCushingoid features vs. primary adrenal insufficiency signsDiagnostic WorkupLaboratory studies (cortisol, ACTH, renin, aldosterone, TSH, etc.)Imaging considerationsGold standard tests and their limitations in the EDTreatmentImmediate administration of hydrocortisoneDosing for adults and pediatricsSupportive care (fluids, glucose, treating underlying cause)Sick day dosing and home managementSpecial PopulationsPregnancy considerationsSeptic shock and adrenal crisisCommon Pitfalls & TakeawaysDelaying steroids for labs/diagnosisImportance of high suspicion and early treatmentKey trivia and learning pointsClosingSummary and final thoughtsReminders for further reading and CMEFarewell and next episode teaserEmergency Medicine Residents, get your free subscription by writing [email protected]