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Adrenal Crisis Management — RACP Adult Medicine MCQ

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EasyEndocrinologyAdrenal Crisis ManagementRACP Adult Medicine

A 50-year-old woman on long-term hydrocortisone replacement for Addison disease presents with vomiting and diarrhoea from gastroenteritis. She has not been able to take her oral hydrocortisone for 24 hours. She is hypotensive (BP 75/40), tachycardic, and confused. Na⁺ 128, K⁺ 6.2, glucose 2.8 mmol/L. What is the most appropriate immediate management?

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Correct answer: D — IV hydrocortisone 100 mg stat then 50 mg q6-8h + IV normal saline

Adrenal crisis (intercurrent illness preventing oral steroid absorption in Addison disease) is a life-threatening emergency. Immediate management: IV hydrocortisone 100 mg stat bolus then 50 mg q6-8h (or continuous infusion 200 mg/24h), rapid IV normal saline (1-2 L over first hour — corrects hypovolaemia and hyponatraemia), IV dextrose if hypoglycaemic, identify and treat the precipitant (gastroenteritis → antiemetics, fluids). Fludrocortisone is not needed acutely (hydrocortisone at stress doses has sufficient mineralocorticoid activity).

Reference: Endocrine Society – 2016 – Adrenal Insufficiency; eTG Endocrine 2024