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Adrenal Crisis — SCE Medical Oncology MCQ

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ModerateOncological EmergenciesAdrenal CrisisSCE Medical Oncology

A 60-year-old woman with metastatic cancer develops bilateral adrenal metastases causing adrenal insufficiency. She presents with lethargy, hypotension (BP 80/50), hyponatraemia (Na 120) and hyperkalaemia (K 6.2). Random cortisol is <50 nmol/L. What is the emergency management?

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Correct answer: D — IV hydrocortisone 100 mg stat then 50 mg QDS, aggressive IV fluid resuscitation, correct electrolytes

Acute adrenal crisis from bilateral adrenal metastases is a medical emergency. Immediate IV hydrocortisone 100 mg bolus followed by 50 mg 6-hourly is the standard emergency treatment (BNF, Endocrine Society guidelines). Aggressive IV fluid resuscitation with normal saline corrects hypovolaemia and hyponatraemia. Hyperkalaemia management (insulin-dextrose, calcium gluconate) may be needed. Long-term mineralocorticoid replacement (fludrocortisone) is added once the acute crisis resolves.

Reference: ESMO 2024 Oncological Emergencies; BNF Hydrocortisone; Endocrine Society Adrenal Crisis Guidelines