Septic shock vs Adrenal crisis
How to tell Septic shock and Adrenal crisis apart when a board question makes them look alike.
Sepsis is infection-led shock; adrenal crisis is refractory shock plus cortisol-failure clues and steroid history.
Side by side
Infection-driven hypotension with fever, high lactate, vasodilation, and poor perfusion.
Refractory hypotension despite fluids or pressors with steroid history, hyponatremia, hypoglycemia, and sometimes hyperkalemia.
Inflammatory mediators cause distributive shock and capillary leak.
Absent cortisol response prevents vascular tone and stress glucose maintenance.
Infectious source and lactate support sepsis.
Hypoglycemia and hyperkalemia after steroid withdrawal support adrenal crisis.
The trap
Adrenal crisis can be triggered by infection, so identifying a source of fever does not exclude it. Refractory hypotension that fails to respond to fluids and vasopressors, especially with hyponatremia, hyperkalemia, hypoglycemia, and history of chronic corticosteroid use or hyperpigmentation (primary adrenal insufficiency), demands empiric hydrocortisone 100 mg IV before cortisol results return. Waterhouse-Friderichsen syndrome (hemorrhagic adrenal necrosis from meningococcemia) is the high-yield infection-triggered case where both diagnoses are simultaneously true.
Watch it explained
The repair move
When hypotension is refractory, check steroid exposure plus glucose, sodium, and potassium.
Try a free question
CoreA patient with pneumonia has hypotension, fever, elevated lactate, and warm extremities early in the illness. Which shock process is most likely?
Show answer and explanation
Answer: A. Septic shock. Infection-led distributive shock with lactate elevation points to septic shock.
Why the other choices are tempting
- B. Adrenal crisis is refractory shock with cortisol-failure clues and often steroid history.
- C. Cardiogenic shock has pump failure and pulmonary edema/high filling pressures.
- D. Hypovolemic shock follows fluid or blood loss.
- E. Anaphylaxis has allergen exposure, urticaria, wheeze, or angioedema.
Flashcards
Tap a card to flip it.
What is the fastest separator for Septic shock vs Adrenal crisis?
Sepsis is infection-led shock; adrenal crisis is refractory shock plus cortisol-failure clues and steroid history.
What clue should make you choose Septic shock?
Infection-driven hypotension with fever, high lactate, vasodilation, and poor perfusion.
Quick answers
What is the fastest way to tell Septic shock from Adrenal crisis?
Sepsis is infection-led shock; adrenal crisis is refractory shock plus cortisol-failure clues and steroid history.
What is the key clue for Septic shock?
Infection-driven hypotension with fever, high lactate, vasodilation, and poor perfusion.
What is the key clue for Adrenal crisis?
Refractory hypotension despite fluids or pressors with steroid history, hyponatremia, hypoglycemia, and sometimes hyperkalemia.
What is the common trap with Septic shock vs Adrenal crisis?
Adrenal crisis can be triggered by infection, so identifying a source of fever does not exclude it. Refractory hypotension that fails to respond to fluids and vasopressors, especially with hyponatremia, hyperkalemia, hypoglycemia, and history of chronic corticosteroid use or hyperpigmentation (primary adrenal insufficiency), demands empiric hydrocortisone 100 mg IV before cortisol results return. Waterhouse-Friderichsen syndrome (hemorrhagic adrenal necrosis from meningococcemia) is the high-yield infection-triggered case where both diagnoses are simultaneously true.