In acute adrenal insufficiency, which laboratory findings are typical?

• A. Hyponatremia and hyperkalemia
• B. Hyperglycemia and glucosuria
• C. Hypercortisolism and hypokalemia
• D. Neutrophilia with increased bands

Answer: (B)

In acute adrenal insufficiency the missing hormones disrupt both sodium handling and glucose regulation. Lack of aldosterone leads to renal salt wasting, so sodium drops in the blood (hyponatremia) and potassium is retained (hyperkalemia). At the same time, cortisol deficiency impairs gluconeogenesis and the body’s ability to mobilize glucose during stress, so hypoglycemia is more common rather than high blood sugar. Glucosuria would typically be seen with hyperglycemia, as in uncontrolled diabetes, not in acute adrenal crisis. So the lab pattern you’d expect is hyponatremia with hyperkalemia, with possible hypoglycemia.