A 47-year-old woman with autoimmune hypothyroidism presents with collapse, vomiting and abdominal pain. Blood pressure is 82/48 mmHg, sodium is 124

Question

A 47-year-old woman with autoimmune hypothyroidism presents with collapse, vomiting and abdominal pain. Blood pressure is 82/48 mmHg, sodium is 124 mmol/L, potassium is 5.9 mmol/L and glucose is 3.1 mmol/L. Hyperpigmentation is noted. What is the most appropriate management?

Accepted Answer

Give immediate intravenous hydrocortisone and isotonic saline after drawing cortisol if feasible

Answer

Give insulin and dextrose as definitive therapy

Answer

Give high-dose thyroxine as the first intervention

Answer

Treat with fluid restriction for hyponatraemia

Answer

Wait for Synacthen test results before treatment

Adrenal crisis — RACP Adult Medicine MCQ

A 47-year-old woman with autoimmune hypothyroidism presents with collapse, vomiting and abdominal pain. Blood pressure is 82/48 mmHg, sodium is 124 mmol/L, potassium is 5.9 mmol/L and glucose is 3.1 mmol/L. Hyperpigmentation is noted. What is the most appropriate management?