What is the immediate management for an adrenal crisis?

• A. IV hydrocortisone plus aggressive IV fluids and electrolyte management
• B. Oral hydrocortisone and rest
• C. Diuretics and electrolyte wasting
• D. Observation only

Answer: (A)

Adrenal crisis is an emergency where there is a severe lack of cortisol and often mineralocorticoid activity, leading to shock, dehydration, and electrolyte abnormalities. The immediate approach must simultaneously restore circulation and replace the deficient hormones.

The best initial management combines aggressive IV fluids with prompt steroid replacement. Start with isotonic IV fluids (normal saline) to rapidly restore intravascular volume, improve blood pressure, and correct electrolyte disturbances. At the same time, give an IV hydrocortisone dose right away (typical pattern is a 100 mg IV bolus, followed by 50 mg IV every 6 hours or a continuous infusion). Hydrocortisone provides both glucocorticoid and mineralocorticoid effects, which helps reverse hypotension and electrolyte derangements characteristic of adrenal crisis.

Oral therapy, waiting for lab results, or relying on observation would miss the life-saving treatment needed in the moment, and diuretics or other non-directed approaches would worsen volume depletion and electrolyte imbalance. After stabilization, transition to oral hydrocortisone and address the underlying trigger while continuing careful monitoring and supportive care.