What is the initial treatment for suspected adrenal crisis?

• A. IV fluids, IV hydrocortisone, and electrolyte/glucose correction
• B. Oral hydrocortisone and electrolyte correction
• C. Insulin therapy with potassium supplementation
• D. Desmopressin therapy

Answer: (A)

Suspected adrenal crisis is a medical emergency that requires immediate stabilization with fluid resuscitation and hormone replacement. The first priority is restoring circulating volume with IV isotonic fluids to treat shock from mineralocorticoid and cortisol deficiency. At the same time, give IV hydrocortisone to replace cortisol (this also provides some mineralocorticoid effect), typically as a 100 mg IV bolus, then 50 mg IV every 6 hours or as a continuous infusion, while you assess the patient and adjust care. While fluids and steroids are underway, correct electrolytes and glucose because adrenal insufficiency often causes hyponatremia, hyperkalemia, and hypoglycemia; if the patient is hypoglycemic, give IV dextrose. After initial stabilization, continue hydrocortisone and arrange for long-term management, including additional mineralocorticoid replacement if needed. Desmopressin and insulin-focused therapies don’t address the urgent need for fluid resuscitation and rapid glucocorticoid replacement in an adrenal crisis, so they’re not appropriate as the initial treatment.