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Adrenal Crisis Prevention — RACP Adult Medicine MCQ

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EasyEndocrinology & DiabetesAdrenal Crisis PreventionRACP Adult Medicine

A 35-year-old woman with known Addison's disease on hydrocortisone and fludrocortisone develops gastroenteritis with vomiting and diarrhoea. She cannot keep her oral medications down. What is the emergency management?

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Correct answer: E — IM hydrocortisone 100 mg then present to hospital

Adrenal crisis in a patient with known Addison's disease who cannot take oral medication is a medical emergency. The patient should administer IM hydrocortisone 100 mg (all patients with adrenal insufficiency should carry an emergency injection kit) and present to the emergency department for IV hydrocortisone and fluid resuscitation. Patients must be educated about sick-day rules: double or triple oral dose for minor febrile illness; switch to parenteral if unable to tolerate oral medications; and never stop steroids abruptly.

Reference: eTG – 2025 – Endocrinology; Endocrine Society – 2016 – Adrenal Insufficiency Guidelines