Which therapy is used for guideline-adherent management of acute adrenal crisis as an initial glucocorticoid replacement?

• A. Hydrocortisone replacement.
• B. Prednisone.
• C. Dexamethasone.
• D. Methylprednisolone.

Answer: (A)

In acute adrenal crisis, you need to replace both cortisol and mineralocorticoid activity quickly to restore vascular tone and fluid balance. Hydrocortisone fits best here because it provides glucocorticoid effects like cortisol and also has mineralocorticoid activity, which helps with salt and water retention and blood pressure support right away.

Guideline-adherent management starts with giving a bolus of hydrocortisone, then continuing IV dosing to maintain adequate cortisol levels as the patient stabilizes. After initial stabilization, you would transition to oral hydrocortisone and add a separate mineralocorticoid if needed for long-term replacement. Other glucocorticoids (prednisone, dexamethasone, methylprednisolone) have little to no mineralocorticoid effect, so they don’t address the full needs of an adrenal crisis as effectively in the acute setting.