Unifying Concepts

Diagnostic Criteria of Acute Adrenal Insufficiency

The Endocrine Society guidelines on the diagnosis and treatment of Acute Adrenal Insufficiency (AAI) defines an adrenal crisis as a medical emergency with hypotension, abdominal symptoms and laboratory abnormalities requiring emergency treatment.

Diagnostic criteria of acute adrenal insufficiency

A. Markedly/severely impaired general condition+at least 2 of the following:

  • Systolic blood pressure<100mmHg (hypotension)
  • Nausea or vomiting
  • Drowsiness or disorientation and slowness
  • Febricula/fever
  • Ion disorders: hyponatremia (< 132 mEq/l) or hyperpotassemia
  • Hypoglycemia

B. Rapid improvement/remission of symptoms after parenteral administration of glucocorticoids (hydrocortisone). In cases of prolonged deficiency, recovery may take>24h

A type A or B criterion is required for the diagnosis of AAI.

Four severity degrees of AAI are defined according to the clinical scenario in which patient care is required, and to the final outcome:

  • Grade 1: outpatient care;
  • Grade 2: in-hospital care;
  • Grade 3: Intensive Care Unit (ICU);
  • Grade 4: death due to adrenal crisis.

The vast majority of episodes of AAI in which medical care is sought correspond to grade 1, except in cases of trauma or accidents.



  1. Dineen R, Thompson CJ, Sherlock M. Adrenal crisis: prevention and management in adult patients. Ther Adv Endocrinol Metab. 2019 Jun 13;10:2042018819848218. [Medline]
  2. Araujo Castro M, Currás Freixes M, de Miguel Novoa P, Gracia Gimeno P, Álvarez Escolá C, Hanzu FA. SEEN guidelines for the management and prevention of acute adrenal insufficiency. Endocrinol Diabetes Nutr (Engl Ed). 2020 Jan;67(1):53-60. English, Spanish. [Medline]


Created May 21, 2024.


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