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Adrenal crisis — SCE Acute Medicine MCQ

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EasyAcute Renal and Metabolic EmergenciesAdrenal crisisSCE Acute Medicine

A 41-year-old woman is assessed on the acute medical unit. She has Addison disease, vomiting, abdominal pain and hypotension. Sodium is 126 mmol/L, potassium 5.9 mmol/L and glucose 3.1 mmol/L. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most appropriate next step in management?

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Correct answer: A — Start intravenous hydrocortisone after blood cultures

Start intravenous hydrocortisone after blood cultures is the best answer because known adrenal insufficiency with shock requires immediate parenteral hydrocortisone and fluids. Give intravenous calcium gluconate immediately is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: Treatment should not wait for cortisol results.

Reference: Society for Endocrinology adrenal crisis guidance