One of the symptoms of an adrenal crisis is back pain (and/or leg pain, and other abdominal pain).  So if the tests do not show any other reason for the pain, the pain could have just been due to her illness, in which case, would mean to give more cortef (like if just doubling, then triple).  Our experience a couple months ago with a fever, and no vomiting - was that the triple oral cortef dose was not working - the endo advised to give the injection even though a triple oral dose had been given 2 hours earlier.  Within one hour of giving the injection, her fever (5.5 year-old daughter) came down from 104.4 to 100.8 and stayed below 101.  She was becoming lethargic & off-color with that high fever, and the injection perked her back up & brought her color back.  There are times in an illness the stomach absorption process shuts down, so any cortef, florinef, motrin or tylenol may not be being absorbed at all, even though no vomiting.  The body shuts down the absorption process so that it can conserve needed energy (which often is in lower supply in an ill person) for other body functions (like transporting oxygen to the brain, fighting the illness, etc.).  I've seen this "absorption shut-down" matter repeatedly in med literature - which is why I agree with giving the injection in a fever-only illness if the person does not seem to be responding to the oral meds.  Sometimes I wonder if an indication of the absorption process not working too well is when a fever is not coming down with motrin or tylenol.