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Perioperative adrenal insufficiency — SCE Acute Medicine MCQ

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ModeratePerioperative Medicine, End-of-Life Care and Patient SafetyPerioperative adrenal insufficiencySCE Acute Medicine

A 70-year-old woman is assessed on the acute medical unit. She takes long-term prednisolone and becomes hypotensive after emergency surgery. Sodium is low, glucose is 3.0 mmol/L and infection is possible. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most appropriate next step in management?

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

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Correct answer: E — Start intravenous hydrocortisone after blood cultures

Start intravenous hydrocortisone after blood cultures is the best answer because steroid-dependent patients under major physiological stress can develop adrenal crisis needing hydrocortisone. Give isotonic crystalloid boluses with frequent reassessment 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: Do not wait for cortisol in an unstable patient.

Reference: Society for Endocrinology adrenal crisis guidance