Early

The endocrine deterioration pattern that can become rapidly fatal is adrenal crisis: an acute, critical shortage of cortisol, often combined with aldosterone deficiency in primary adrenal insufficiency. Cortisol is not merely a “stress hormone.” During illness, trauma, surgery, vomiting, or severe pain, it helps maintain vascular responsiveness to catecholamines and supports glucose availability. Without enough cortisol, blood vessels do not respond normally to the body’s attempts to preserve blood pressure. The patient can become profoundly hypotensive despite appearing initially to have a simple gastrointestinal illness or dehydration. In primary adrenal insufficiency, aldosterone deficiency compounds the problem. The kidneys lose sodium and water while retaining potassium. Intravascular volume falls, hyponatremia and hyperkalemia may develop, and shock can progress quickly. Glucocorticoid-induced adrenal insufficiency creates a different route to the same danger. Chronic exogenous glucocorticoids suppress the hypothalamic-pituitary-adrenal axis. If the medication is stopped abruptly, tapered too rapidly, or cannot be absorbed during vomiting, the adrenal glands may not produce the additional cortisol required during physiologic stress. Exposure as low as 4–6 mg prednisone daily, approximately 15 mg hydrocortisone equivalent, for 3 weeks...