MBBS OSCE · Endocrinology
OSCE — Adrenal Insufficiency
Eight-minute OSCE station on Adrenal Insufficiency: focused history, examination priorities, investigations, emergency and definitive management.
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Brief (to candidate)
You will assess a patient with a presentation consistent with Adrenal Insufficiency.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Adrenal insufficiency is the clinical syndrome arising from inadequate production of glucocorticoid (cortisol), with or without mineralocorticoid (aldosterone) and adrenal androgen deficiency. Primary adrenal insufficiency (Addison disease) results from destruction of the adrenal cortex — autoimmune in the West, tuberculosis worldwide — producing low cortisol AND low aldosterone with HIGH ACTH-driven hyperpigmentation, hyponatraemia and hyperkalaemia. Secondary adrenal insufficiency results from pituitary ACTH deficiency, and tertiary from hypothalamic CRH deficiency (most often chronic exogenous glucocorticoid therapy); both spare the mineralocorticoid axis (RAAS intact) so there is no hype
Candidate tasks
- Clarify onset, severity, associated features, and red-flag symptoms.
- State focused examination priorities.
- List first-line investigations and any named score/criteria.
- Give immediate resuscitation steps.
- Outline definitive management with doses/routes where standard.
- Name complications and disposition (ward / HDU / theatre / discharge safety-net).
- Mention one special-population modifier (pregnancy, child, elderly, CKD).
Examiner checklist
| Domain | Pass behaviours |
|---|---|
| Definition | Correct working diagnosis language |
| Assessment | Focused, prioritised, red flags sought |
| Investigations | Appropriate first-line + interpretation |
| Emergency care | ABC / time-critical actions first |
| Definitive care | Specific drugs/procedures, not generic phrases |
| Safety | Hypotension, abdominal pain and vomiting with hyponatraemia and hyperkalaemia in |
| Safety | Known adrenal insufficiency with vomiting and unable to absorb oral hydrocortiso |
| Safety | Hyponatraemia with hypoglycaemia and hyperkalaemia out of proportion to renal fu |
| Communication | Clear plan and safety-netting |
Model outline
Lead with the working diagnosis and life threats. Resuscitate before definitive tests when unstable. Use guideline-standard therapy with named agents and doses. Document escalation criteria and follow-up. A safe candidate is specific, structured, and never delays critical care for non-urgent imaging.