"Most probably" other signs of an adrenal crisis would be present, but I don't believe that "other adrenal crisis signs would ALWAYS be present."  I've got a story to tell, but can only post a few details of it on this board.  We had a day where my 2.5 year-old daughter vomited (salt-wasting CAH), she was given the IM immediately after that first vomiting, and the vomiting did not stop.  When arriving at the hospital that same day, her glucose measured 33.  At the point her glucose measured 33, she was still walking around  (in the hospital room).  A vomiting illness seems to rapidly give rise to a low blood glucose situation (apparently she still should have had IM cortisol in her - she had just vomited once when the IM was given, so she shouldn't have been much, if any, into dehydration when the IM was given) .. but yet blood glucose fell like that ... so don't ever rely on the IM to be a cure-all for the child, and like many endos have told me --- don't ever rely on that the IM will work at all.   I can't post on this board the adrenal crisis symptoms in that illness.