The chief clinical manifestation of Addisonian crisis is:

The chief clinical manifestation of an Addisonian crisis is shock, which represents a life-threatening situation characterized by severe adrenal insufficiency. In an Addisonian crisis, the adrenal glands do not produce enough cortisol, leading to a cascade of physiological responses that can result in inadequate blood flow and oxygen delivery to tissues. This manifests as hypotension, altered mental status, and signs of shock, including weak and rapid pulse, cool and clammy skin, and possibly even loss of consciousness.

While elevated temperature, lower back pain, and dehydration can be associated with various acute medical conditions, they are not the hallmark indicators of an Addisonian crisis. Elevated temperature is typically more indicative of infection or inflammatory processes, lower back pain is not classically associated with adrenal insufficiency, and while dehydration can occur due to lack of aldosterone (leading to electrolyte imbalance), it is the profound shock from adrenal crisis that is most critical and life-threatening.