Objectives: Adrenal gland hypertrophy can be related to acute stress with abnormal adrenal function tests. It may not always need treatment. Material and methods: An acute presentation of adrenal gland hypertrophy following an abdominal emergency, with subsequent hypoadrenalism was investigated. Results: Adrenal medullary and cortical function fully recovered without treatment. Conclusions:We postulate that the adrenal glands became enlarged and hypertrophied during an acute stress event, possibly caused by acute adrenal medullary hypersecretion and subsequent cortical hyposecretion. A wait and watch policy should be followed if no other clinical symptoms and signs of adrenal disease are present. CT scan remains an important diagnostic tool. LEARNING POINTS• Abnormal adrenocortical function tests and hypertrophy can occur in an acutely ill patient as a stress response.• It is possible to have both hypersecretion and hyposecretion of adrenal hormones.• A wait and watch policy should be followed if no other clinical symptoms and signs of adrenal disease are present in an acutely ill patient. KEYWORDS Adrenal gland hypertrophy, transient adrenal insufficiency, reversible adrenal dysfunction, transient adrenal medullary hyperactivity, stress related hypertension. INTRODUCTIONThe adrenal medulla and cortex participate in the response to acute stress

Bilateral adrenal haemorrhage should be considered as a differential diagnosis in patients presenting with non-specific symptoms and hypotension postoperatively.

HbA1c can be affected by determinants other than glucose and an awareness of this is important to avoid unnecessary hypoglycaemia.

Abstract:Objectives: Primary adrenal insufficiency AI is regarded as a progressive disease needing lifelong replacement therapy, but this may not always be the case. Material and methods:A non--acute presentation of AI following a hypotensive episode caused by blood loss was investigated.Results: Adrenal function fully recovered without treatment. Conclusions: There should be a high index of suspicion and a low threshold for performing tests ofadrenal function in survivors of critical illness and severe hypotensive episodes.