Adrenal Crisis in Emergency Medicine Differential Diagnoses

Updated: Oct 10, 2022
  • Author: Kevin M Klauer, DO, EJD, FACEP; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Diagnostic Considerations

Etomidate and adrenal insufficiency

Etomidate is perhaps the most common induction agent used for rapid sequence intubation in the ED and is frequently used as an induction agent for general anesthesia. Although this agent is particularly useful in hemodynamically unstable patients, the potential for precipitation of acute adrenal insufficiency, even following a single dose, must be recognized.

Etomidate is a steroid synthesis inhibitor and, thus, may inhibit production of glucocorticoids. Of particular note is the potential to worsen hemodynamics in patients suffering from septic shock, a patient population that may benefit from supplemental corticosteroid administration. [16]

Differential Diagnoses