**8. Adrenal Crisis**

Adrenal crisis can occur when infection and injury are complicated by adrenocortical insufficiency, and it progresses to a fatal disease state via absolute and relative steroid deficiency. Primary/secondary adrenal insufficiency due to ICI treatment may also lead to adrenal crisis, and early diagnosis and appropriate measures should be implemented at onset. The initial symptoms of adrenal crisis, like those of adrenal insufficiency, are nonspecific and include general malaise, anesthesia, loss of appetite, weight loss, nausea, abdominal pain, and fever. However, after >12 h, consciousness disturbance and hypotension can occur.

Blood tests often show hyponatremia, hyperkalemia, hypoglycemia, dehydration, and eosinophilia. When adrenal crisis is suspected on the basis of the medical history and test results, immediate measures should be taken while excluding other conditions such as sepsis. Initial treatment includes infusion of a large volume of saline, glucose solution, and hydrocortisone. Measurements of blood cortisol and ACTH are useful for diagnosis.
