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Pubertal induction – testosterone — RACP Paediatrics MCQ

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HardEndocrinePubertal induction – testosteroneRACP Paediatrics

A 10-year-old with congenital adrenal hyperplasia is scheduled for urgent appendicectomy. He is haemodynamically stable and took his normal morning hydrocortisone. What perioperative steroid plan is appropriate?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Give hydrocortisone 50 mg intravenously at induction and six-hourly thereafter

Explanation lettering: B = shown as A · A = shown as B · D = shown as C · E = shown as D · C = shown as E

B is correct. Children aged 3–12 years with adrenal insufficiency receive 50 mg parenteral hydrocortisone at induction for surgery, followed by age-appropriate six-hourly stress dosing. A risks crisis. C mineralocorticoid alone cannot provide the cortisol stress response. D an oral doubling regimen is insufficient for major operative stress. E a single alternative steroid dose without continued replacement is unsafe.

Reference: RCH Melbourne, Adrenal crisis and acute adrenal insufficiency: https://www.rch.org.au/clinicalguide/guideline_index/Adrenal_crisis_and_acute_adrenal_insufficiency/