After bilateral adrenalectomy, the patient must be on lifelong steroids to prevent what condition?

• A. Addisonian crisis
• B. Hyperkalemia
• C. Hypothyroidism
• D. Hypoglycemia

Answer: (A)

After removing both adrenal glands, the body loses cortisol and aldosterone, so it cannot mount an adequate stress response. Without replacement, any illness, surgery, or even significant stress can trigger a life-threatening adrenal crisis (Addisonian crisis) characterized by severe hypotension, shock, dehydration, and dangerous electrolyte and glucose disturbances. Lifelong steroid therapy is essential to prevent this crisis by supplying the missing glucocorticoids (and, with appropriate regimens, mineralocorticoids as well) so the body can maintain vascular tone, glucose production, and fluid/electrolyte balance. While mineralocorticoid replacement helps with electrolyte issues like hyperkalemia, the central reason for lifelong steroids is to avert an Addisonian crisis. Hypothyroidism isn’t caused by adrenal loss, and hypoglycemia is a feature of crisis rather than the preventive target.