Adrenal crisis in active duty service members

Primary adrenal insufficiency is a chronic, debilitating condition that usually produces a variety of characteristic but non-specific clinical features. Up to 25% of patients present instead with acute life-threatening adrenal crisis, marked by severe hypotension and shock. Recognition of the disease in the chronic indolent phase is critical because adrenal steroid replacement effectively relieves symptoms and prevents the development of most acute crises. To illustrate these points, we describe four case histories in which the manifestations of chronic adrenal insufficiency went unrecognized in active duty service members until they presented with near-fatal adrenal crises. The salient clinical features, diagnosis, and treatment of the disease are also reviewed.