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Steroid-withdrawal adrenal crisis — SCE Acute Medicine MCQ

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EasyAcute Rheumatological and Dermatological EmergenciesSteroid-withdrawal adrenal crisisSCE Acute Medicine

A 63-year-old woman presents with rash, allergic features, visual symptoms or systemic inflammation. Relevant history includes recent drug exposure, autoimmune disease or allergen exposure. On assessment, skin, mucosal or vascular findings suggest systemic disease. Investigations show shock, hyponatraemia, hyperkalaemia and abrupt prednisolone cessation. What is the most important immediate action?

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

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Correct answer: B — Give intravenous hydrocortisone and isotonic saline immediately

The key discriminator is that shock, hyponatraemia, hyperkalaemia and abrupt prednisolone cessation, which makes Give intravenous hydrocortisone and isotonic saline immediately the single best answer. Give hypertonic saline bolus is less appropriate because it does not address the dominant acute risk in the vignette; Reverse anticoagulation where appropriate would fit a different presentation or later stage of care. Give intramuscular adrenaline immediately and Give high-flow oxygen are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: Society for Endocrinology adrenal crisis guidance