Endocrine shock may present as a combination of hypovolae- mic, cardiogenic or distributive shock. Causes of endocrine shock include hypo- and hyperthyroidism and adrenal insuf- ficiency. Hypothyroidism causes a shock state similar to that of neurogenic shock due to disordered vascular and cardiac responsiveness to circulating catecholamines. Cardiac output falls due to low inotropy and bradycardia. There may also be an associated cardiomyopathy. Thyrotoxicosis may cause a high-output cardiac failure. Adrenal insufficiency leads to shock due to hypovolaemia and a poor response to circulating and exogenous catecho- lamines. Adrenal insufficiency may be due to pre-existing Addison’s disease or be a relative insufficiency due to a patho- logical disease state, such as systemic sepsis.