Adrenal crisis must be considered if ≥1 type A criterion and ≥2 type B criteria can be applied:

Type A criteria:

• History of adrenal insufficiency or previous glucocorticoid therapy for other diseases
• Hyponatraemia ≤132 mmol/L
• Hyperkalaemia

Type B criteria:

• Severe weakness or fatigue
• Impaired consciousness
• Nausea and/ or vomiting
• Fever
• Hypotension with systolic blood pressure ≤100 mmHg

Management of an acute adrenal crisis

• sufficient intravenous volume replacement
• 100 mg hydrocortisone as an intravenous bolus injection
• followed by 200 mg as a continuous infusion over 24 h*
• for children dose adjustment according to body weight or body surface area

*If hydrocortisone is not available, alternative glucocorticoids (i.e. prednisolone in a dosage of at least 25 mg) can be used for emergency treatment of acute adrenal crisis.