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Adrenal crisis — RACP Paediatrics MCQ

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ModerateEndocrineAdrenal crisisRACP Paediatrics

A 3-year-old with known congenital adrenal hyperplasia presents to the emergency department with gastroenteritis, vomiting, and lethargy. He is unable to take oral medications. Blood glucose is 2.5 mmol/L. Na 128, K 6.1. What is the most appropriate immediate management?

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Correct answer: D — IV hydrocortisone 2 mg/kg stat

An adrenal crisis in a known CAH patient (unable to take oral medications with hypoglycaemia, hyponatraemia, hyperkalaemia) requires immediate IV hydrocortisone at stress dose (2 mg/kg, max 100 mg stat) along with IV fluid resuscitation with 0.9% NaCl + 5% dextrose. This is a life-threatening emergency.

Reference: RCH Melbourne – 2023 – Adrenal Crisis CPG; RACP Paediatric Curriculum – Endocrine