Omori et al identified patients with adrenal insufficiency who are at increased risk for an adrenal crisis. These patients may benefit from more aggressive management. The authors are from Tokyo Women's Medical University.


Patient selection: primary or secondary adrenal insufficiency


Risk factors associated with adrenal crisis:

(1) steroid replacement therapy for > 4 years (indicating long-standing disease)

(2) presence of a mental disorder (psychiatric disturbance, dementia, etc)

(3) untreated sex steroid deficiency (amenorrhea in female, low serum testosterone in a male)


Treating sex steroid deficiency is an intervention that can reduce the risk of an adrenal crisis in these patients.


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