A 55-year-old has vomiting, hyperpigmentation, sodium 124 mmol/L, potassium 5.9 mmol/L, glucose 3.2 mmol/L and blood pressure 82/46 mmHg. Morning

Question

A 55-year-old has vomiting, hyperpigmentation, sodium 124 mmol/L, potassium 5.9 mmol/L, glucose 3.2 mmol/L and blood pressure 82/46 mmHg. Morning cortisol is very low and ACTH is markedly elevated. What treatment should begin immediately?

Accepted Answer

Give parenteral hydrocortisone with isotonic saline

Answer

Start levothyroxine before glucocorticoid replacement

Answer

Treat hyponatremia with fluid restriction alone

Answer

Perform cosyntropin testing before replacing glucocorticoid

Answer

Give fludrocortisone alone and reassess blood pressure

Primary adrenal insufficiency — RCPSC IM MCQ

A 55-year-old has vomiting, hyperpigmentation, sodium 124 mmol/L, potassium 5.9 mmol/L, glucose 3.2 mmol/L and blood pressure 82/46 mmHg. Morning cortisol is very low and ACTH is markedly elevated. What treatment should begin immediately?