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 Insufficiency
- Introduction
- Welcome and host introductions
- Brief overview of the episode’s topic
- Resources and CME reminder
- Article Overview
- Source: Emergency Medicine Practice, October 2025
- Authors: The Simcoes
- Importance of evidence-based review
- Clinical Context & Epidemiology
- Frequency and rarity of adrenal insufficiency
- Diagnostic challenges and statistics
- Importance of recognizing adrenal crisis
- Pathophysiology
- Primary, secondary, and tertiary adrenal insufficiency
- Causes and mechanisms
- Key anatomical and physiological concepts
- Differential Diagnosis
- Overlap with other diseases (infections, autoimmune, endocrine, psychiatric, cardiac, GI, etc.)
- Importance of considering adrenal crisis in complex cases
- Prehospital Care
- EMS recognition and limitations
- Importance of medication history and emergency kits
- Legal and logistical barriers to prehospital hydrocortisone
- Emergency Department Evaluation
- Recognizing symptoms and prioritizing care
- Role of EMR and clinical decision support
- Key history and risk factors (medications, steroid use, opioid use, comorbidities)
- Physical Examination
- Specific and nonspecific findings
- Cushingoid features vs. primary adrenal insufficiency signs
- Diagnostic Workup
- Laboratory studies (cortisol, ACTH, renin, aldosterone, TSH, etc.)
- Imaging considerations
- Gold standard tests and their limitations in the ED
- Treatment
- Immediate administration of hydrocortisone
- Dosing for adults and pediatrics
- Supportive care (fluids, glucose, treating underlying cause)
- Sick day dosing and home management
- Special Populations
- Pregnancy considerations
- Septic shock and adrenal crisis
- Common Pitfalls & Takeaways
- Delaying steroids for labs/diagnosis
- Importance of high suspicion and early treatment
- Key trivia and learning points
- Closing
- Summary and final thoughts
- Reminders for further reading and CME
- Farewell and next episode teaser
Emergency Medicine Residents, get your free subscription by writing resident@ebmedicine.net
Sam Ashoo, MD, FACEP, is board certified in emergency medicine and clinical informatics. He serves as EB Medicine’s editor-in-chief of interactive clinical pathways and FOAMEd blog, and host of EB Medicine’s EMplify podcast. Follow him below for more…
