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Adrenal crisis due to missed steroid replacement — SCE Acute Medicine MCQ

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ModerateDiabetes and endocrine medicineAdrenal crisis due to missed steroid replacementSCE Acute Medicine

A 39-year-old woman with Addison's disease presents with vomiting, abdominal pain and collapse after gastroenteritis. Blood pressure is 78/46 mmHg, sodium is 123 mmol/L, potassium is 6.1 mmol/L and glucose is 3.1 mmol/L. She has missed steroid doses for 24 hours. What is the most appropriate next step in management?

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Correct answer: C — Give intramuscular or intravenous hydrocortisone immediately with intravenous saline and glucose as needed

Adrenal crisis is life-threatening and treatment with hydrocortisone and fluid resuscitation must not wait for confirmatory tests. Hyperkalaemia and hyponatraemia support mineralocorticoid deficiency, but hydrocortisone provides urgent glucocorticoid effect and some mineralocorticoid activity at stress doses. Blood can be taken for cortisol if this does not delay treatment.

Reference: Society for Endocrinology emergency guidance on adrenal crisis; NICE CKS Addison's disease