• addison's disease
• chronic steroid use
• Waterhouse-Friedrichson syndrome (adrenal infarction due to DIC)
• Pituitary apoplexy (pit infarction esp post partum, DIC)
• Oncology - checkpoint inhib immunotherapy
• Look for precipitants: -infection, trauma, pregnancy, reduced steroid use. Initiation of carbamazepine, etomidate, phenytoin etc

• Vasodilatory shock esp refractory to fluid
• N,V, abdo pain, fever, delirium

• low Na+, high K+, low Glu

**NB - It is a Dx of exclusion. Rapid response to steroid is supportive of Dx

• look for triggers and treat
• hydrocortisone esp if known adrenal insufficiency
• dexamethasone - ??? esp if not known insufficiency - check
• supportive