Adrenal Crisis Emergency — ORE Part 1 MCQ

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ModeratePharmacology & TherapeuticsAdrenal Crisis EmergencyORE Part 1

An adult with known adrenal insufficiency becomes pale, weak and confused during dental treatment. They are hypotensive and unable to take oral medication. An acute adrenal crisis is suspected. What is the most appropriate immediate management in the dental surgery?

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Correct answer: D — Give IM hydrocortisone 100 mg and call 999

**A is correct.** Hypotension, confusion and inability to take oral medication in a person with known adrenal insufficiency indicate suspected adrenal crisis. NICE recommends immediate parenteral hydrocortisone and transfer to hospital by ambulance; in a dental surgery, give the available emergency IM hydrocortisone dose of 100 mg while arranging 999 transfer. Place the patient supine if tolerated, assess and manage ABCDE, and provide oxygen if clinically indicated, but these measures must not delay hydrocortisone. IM adrenaline is appropriate for anaphylaxis, not adrenal crisis. Glyceryl trinitrate and aspirin target suspected acute coronary syndrome and do not replace deficient cortisol. Oral glucose may be relevant for confirmed hypoglycaemia in a conscious patient able to swallow, but is unsafe or inadequate here and does not treat the crisis.

Reference: NICE. Adrenal insufficiency: identification and management (NG243), section 1.7, Emergency management of adrenal crisis, 2024 (minor updates October 2025). https://www.nice.org.uk/guidance/NG243/chapter/recommendations