What is the initial management step in suspected adrenal crisis?

What is the initial management step in suspected adrenal crisis?

• A. Immediate IV hydrocortisone (e.g., 100 mg) and aggressive isotonic IV fluids, plus search for reversible causes.
• B. Oral hydrocortisone
• C. Start antibiotics
• D. Avoid steroids until diagnosis confirmed

Answer: (A)

In suspected adrenal crisis, the priority is rapid stabilization of the patient’s circulation and glucose, because cortisol deficiency can cause life-threatening shock. The best first step is immediate intravenous hydrocortisone together with aggressive isotonic IV fluids. Hydrocortisone provides both glucocorticoid and mineralocorticoid effects quickly, helping to raise blood pressure and improve vascular tone. Give a 100 mg IV bolus of hydrocortisone right away, then continue with 50 mg IV every 6 hours (or a continuous infusion) as the patient is being stabilized. Start isotonic saline promptly to restore intravascular volume and perfusion, and monitor and correct electrolytes and glucose as needed. Do not delay steroids for diagnostic confirmation or rely on oral steroids in shock, and antibiotics are only added if an infection is suspected as a trigger rather than the initial step. The aim is to treat the crisis immediately while evaluating and addressing reversible causes.

In suspected adrenal crisis, the priority is rapid stabilization of the patient’s circulation and glucose, because cortisol deficiency can cause life-threatening shock. The best first step is immediate intravenous hydrocortisone together with aggressive isotonic IV fluids. Hydrocortisone provides both glucocorticoid and mineralocorticoid effects quickly, helping to raise blood pressure and improve vascular tone. Give a 100 mg IV bolus of hydrocortisone right away, then continue with 50 mg IV every 6 hours (or a continuous infusion) as the patient is being stabilized. Start isotonic saline promptly to restore intravascular volume and perfusion, and monitor and correct electrolytes and glucose as needed. Do not delay steroids for diagnostic confirmation or rely on oral steroids in shock, and antibiotics are only added if an infection is suspected as a trigger rather than the initial step. The aim is to treat the crisis immediately while evaluating and addressing reversible causes.