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Adrenal crisis — ABIM Board MCQ

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HardEndocrinology/MetabolismAdrenal crisisABIM Board

A 44-year-old woman has fatigue, weight loss, salt craving, and dizziness. Blood pressure is 88/54 mm Hg, sodium is 126 mEq/L, potassium is 5.8 mEq/L, and glucose is 58 mg/dL. Morning cortisol is 2 mcg/dL and ACTH is elevated. She appears ill and vomits repeatedly. Which of the following is the most appropriate management?

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Correct answer: E — Intravenous hydrocortisone and isotonic saline with dextrose

This is primary adrenal insufficiency with adrenal crisis physiology. Treatment should not be delayed for confirmatory testing in an unstable patient; intravenous hydrocortisone and volume/glucose resuscitation are indicated.

Reference: Endocrine Society Primary Adrenal Insufficiency Guideline