Primary adrenal insufficiency from autoimmune destruction (commonest), TB, metastases.
History taking
- • Fatigue, weight loss, postural dizziness, salt craving, hyperpigmentation
Examination
- • General: vitals, pallor, icterus, oedema, lymphadenopathy
- • Focused system examination
- • Look for red-flag findings
Red flags
- • Haemodynamic instability
- • Rapid deterioration
- • Severe pain or new neurological deficit
Differential diagnosis
- • See differentials section per chief complaint
Recommended investigations
- • Morning cortisol, ACTH, short Synacthen test
- • U&E (low Na, high K), adrenal antibodies
Diagnosis
- • Clinical diagnosis supported by targeted investigations
Initial treatment / management
- • Treat underlying cause
- • Symptomatic relief
- • Patient education
Drug therapy
- • Hydrocortisone 15–25 mg/day in divided doses + fludrocortisone 50–200 µg OD
Follow-up advice
- • Review in 2–4 weeks or earlier if worsening
- • Monitor response to therapy and adverse effects
Patient counselling
- • Sick-day rules: double dose, IM hydrocortisone 100 mg if vomiting
- • MedicAlert bracelet
Referral criteria
- • Refer if diagnostic uncertainty, complications, or failure of first-line therapy
References
- • Harrison's Principles of Internal Medicine, 21e
- • NICE / WHO guidelines (current edition)
Educational outpatient guide — verify against local guidelines before clinical use.
