Division of Emergency Medicine, Department of Surgery, The University of Vermont Larner College of Medicine, Burlington, Vermont.
Emergency Medicine Residency, The University of Vermont Larner College of Medicine, Burlington, Vermont.
J Emerg Med. 2022 Aug;63(2):212-220. doi: 10.1016/j.jemermed.2022.06.005. Epub 2022 Aug 26.
Adrenal insufficiency can result in significant patient morbidity and mortality, but due to the range of symptoms and variable clinical course and etiologies, it can be a challenging condition to diagnose and manage.
This narrative review will discuss the evaluation of an adult patient at risk for a new diagnosis of adrenal insufficiency and the management of a patient with known or suspected adrenal insufficiency.
A new presentation of adrenal insufficiency can range from nonspecific, minor symptoms including fatigue, to a life-threatening adrenal crisis with hemodynamic instability. Due to the variety of signs and symptoms, the diagnosis is often missed. Those with known adrenal insufficiency are at risk for adrenal crisis, which may occur due to a variety of triggers. Initial evaluation includes assessment for the underlying etiology or concomitant condition, laboratory analysis, and imaging, when clinically indicated. Although not necessary for evaluation in the emergency department setting, the diagnosis is confirmed by specific testing such as the cosyntropin stimulation test. The mainstay of treatment in adrenal crisis is hydrocortisone, intravenous fluid, glucose repletion, and treatment of the underlying acute trigger.
Emergency clinicians must be prepared to recognize, evaluate, and manage those with known or suspected adrenal insufficiency or adrenal crisis.
肾上腺功能不全可导致患者出现严重的发病率和死亡率，但由于其症状范围广泛，临床过程和病因多变，因此诊断和管理具有一定挑战性。
本文将讨论评估有新发肾上腺功能不全风险的成人患者的方法，以及管理已知或疑似肾上腺功能不全患者的方法。
新发肾上腺功能不全的表现范围从非特异性、轻微的症状（如疲劳）到伴有血流动力学不稳定的危及生命的肾上腺危象。由于各种体征和症状的存在，诊断常常被忽视。已知患有肾上腺功能不全的患者存在发生肾上腺危象的风险，这种危象可能由多种诱因引起。初始评估包括对潜在病因或合并症的评估、实验室分析以及有临床指征时的影像学检查。虽然在急诊科环境中并非必需，但特定的检测（如促皮质素刺激试验）可用于确诊。肾上腺危象的主要治疗方法是给予氢化可的松、静脉补液、葡萄糖补充以及治疗潜在的急性触发因素。
急诊临床医生必须做好准备，以识别、评估和治疗已知或疑似肾上腺功能不全或肾上腺危象的患者。
