What are the hallmark features of an adrenal crisis and the initial treatment steps?

• A. Severe hypotension, dehydration, hyponatremia, hyperkalemia, hypoglycemia; treat with IV hydrocortisone, aggressive IV fluids (normal saline), and correct electrolytes.
• B. Hypernatremia and hypokalemia; oral hydrocortisone.
• C. Mild fatigue; no steroids.
• D. Hyperglycemia; subcutaneous insulin.

Answer: (A)

Adrenal crisis is an acute, life-threatening lack of adrenal hormones that leads to severe vasodilation failure and volume depletion. The key clues are a combination of very low blood pressure with dehydration, hyponatremia, hyperkalemia, and hypoglycemia. This pattern reflects the loss of both cortisol (affecting glucose and vascular tone) and aldosterone (affecting sodium and potassium balance), so you get shock plus electrolyte disturbances.

The best approach is to treat both the hormone deficiency and the shock right away. Give IV hydrocortisone promptly because it covers both glucocorticoid and mineralocorticoid needs in the crisis. A typical plan is a 100 mg IV bolus, then 50 mg IV every 6 hours (or a continuous infusion) until the patient stabilizes. Start aggressive isotonic saline to restore intravascular volume and perfusion, often with large initial fluid resuscitation.

As the patient responds, monitor and correct electrolytes and glucose. Hyponatremia and hyperkalemia improve as volume status and hormonal support are restored, and hypoglycemia is treated with dextrose-containing fluids if present. Workup and treatment should continue to address any precipitating trigger once stabilized.

The other options don’t fit adrenal crisis: hypernatremia with hypokalemia isn’t typical; a mild, non-steroidal presentation doesn’t reflect the emergency needed; and hyperglycemia with insulin therapy isn’t aligned with the hypoglycemia that can accompany adrenal insufficiency.