emDOCs EM@3AM - By Rahul Ramraj; Pinaki Mukherji
Reviewed by: Sophia Görgens; Cassandra Mackey; Brit Long
Pearls
- Consider CS when one sensitive and one specific sign (i.e.: obesity + striae; hirsutism + new psychosis)
- Begin empiric treatment if severe CS suspected: metyrapone, ketoconazole, or etomidate
- Confirm suspicion with random serum cortisol > 36 µg/dL (1000 nmol/L)
- Treat associated disorders – cardiovascular disease (cardiac failure, hypertension), venous thrombosis, infections (sepsis, peritonitis), metabolic complications (diabetes, hypokalemia)
- Bilateral adrenalectomy – when refractory to medical interventions in severe CS