Missed Addisonian crisis in surgical wards

Three women were admitted to the surgical wards with acute gastro-intestinal symptoms and despite good clinical (pigmentation, hypotension) and biochemical (hyponatraemia, acidosis) evidence of Addisonian crisis had unnecessary investigations with delay in the diagnosis and appropriate management of this medical emergency. Clinicians should take careful note of the typical electrolyte upset seen in Addisonian crisis.