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Adrenal crisis — SCE Endocrinology MCQ

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EasyAdrenalAdrenal crisisSCE Endocrinology

A 57-year-old man is admitted with septic shock and has autoimmune Addison's disease. He is hypotensive despite initial fluids, sodium is 126 mmol/L, potassium 5.9 mmol/L and glucose 3.1 mmol/L. His partner says he has vomited his usual steroid tablets. What is the most appropriate management?

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Correct answer: A — Give hydrocortisone 100 mg intravenously and 0.9% sodium chloride

Give hydrocortisone 100 mg intravenously and 0.9% sodium chloride is best because suspected adrenal crisis should be treated immediately with parenteral hydrocortisone and isotonic fluid without waiting for confirmation. The alternatives are less appropriate because oral fludrocortisone is too slow; testing should not delay treatment; hypertonic saline alone misses cortisol deficiency; oral rescue is unreliable with vomiting. The SCE teaching point is to integrate the clinical pattern, biochemistry and context rather than treating an isolated result.

Reference: NICE NG243; Society for Endocrinology adrenal crisis guidance