Adrenal Crisis — ORE Part 1 MCQ

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ModeratePharmacology & TherapeuticsAdrenal CrisisORE Part 1

A patient with a history of Addison disease (adrenal insufficiency) becomes hypotensive, confused, and unwell during a dental procedure. What is the most appropriate emergency treatment?

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Reveal the answer and explanation

Correct answer: E — Intramuscular hydrocortisone 100 mg and call 999

Explanation lettering: D = shown as A · E = shown as C · C = shown as D · A = shown as E

In suspected adrenal crisis, immediate IM hydrocortisone 100 mg followed by emergency ambulance call (999) is the evidence-based standard. NICE guidance and NHS protocols are unequivocal: parenteral hydrocortisone is life-saving because it directly replaces the absent cortisol causing circulatory collapse. Oral agents (B) fail in shock due to poor GI absorption. Adrenaline (C) is not indicated—adrenal crisis requires glucocorticoid replacement, not sympathomimetic support. IV saline (D) is supportive but insufficient alone; hydrocortisone must precede or accompany fluid resuscitation. Positioning (E) provides no definitive treatment. The 100 mg IM dose is rapid-acting, bypasses absorption problems, and is the recognised standard in UK emergency and dental practice.

Reference: NICE NG243: Adrenal insufficiency: identification and management (August 2024); NHS Pharmaceutical Services: Supporting safe use of adrenal crisis emergency management kits (November 2024). https://www.nice.org.uk/guidance/ng243 and https://sps.nhs.uk/articles/supporting-safe-use-of-adrenal-crisis-emergency-management-kits/