A 52-year-old woman on ICU with septic shock is noted to have developed bilateral adrenal haemorrhage on CT abdomen performed for another indication. ...

Question

A 52-year-old woman on ICU with septic shock is noted to have developed bilateral adrenal haemorrhage on CT abdomen performed for another indication. She has suddenly become more vasopressor-dependent. Cortisol level returns as critically low (45 nmol/L). What is the immediate treatment?

Accepted Answer

IV hydrocortisone 100 mg stat bolus followed by 50 mg IV QDS, plus aggressive IV fluid resuscitation with 0.9% saline

Answer

Oral hydrocortisone 10 mg TDS

Answer

IV dexamethasone 4 mg only

Answer

IM Synacthen test before treatment

Answer

Oral fludrocortisone only

uk-fficm MCQ (SBA): Acute Adrenal Crisis

A 52-year-old woman on ICU with septic shock is noted to have developed bilateral adrenal haemorrhage on CT abdomen performed for another indication. She has suddenly become more vasopressor-dependent. Cortisol level returns as critically low (45 nmol/L). What is the immediate treatment?