This case study is part of the Nurses session -Adrenal Crisis and steroid education.The incidence of Adrenal Crisis in secondary Adrenal Insufficiency is high and associated with substantial mortality. However the etiology is not always obvious. Advances in comprehensive patient education including self-administration of hydrocortisone is crucial to eliminate death from Adrenal Crisis. Other advances in the United Kingdom have been implemented to assist allied health care professionals in the identification of patients at risk. This case study will explore unusual etiology and examine current resources available to help to identify patients at risk.