Acute Mx of Adrenal Crisis

Q: All of the following are part of the immediate (acute) management of adrenal crisis except?

A) Immediate glucose check
B) Infusion of 5% dextrose in isotonic saline
C) 4 mg dexamethasone (decadron) 
D) 0.1 mg fludrocortisone
E) large-bore intravenous access


Answer: D

All of the above are required immediately to avoid the hemodynamic collapse of a patient with adrenal crisis except fludrocortisone. Mineralocorticoid replacement (fludrocortisone) takes several days to induce its sodium-retaining effects, and in immediate phase sodium replacement should be done via IV normal saline. D-5 is added to IV saline to treat hypoglycemia of adrenal crisis.

Also, out of primary, secondary and tertiary adrenal inefficiencies, only primary adrenal insufficiency is associated with both cortisol and mineralocorticoid deficiency.

#endocrinology


References: 

1. Hahner S, Allolio B. Therapeutic management of adrenal insufficiency. Best Pract Res Clin Endocrinol Metab. 2009 Apr. 23(2):167-79. 

2. Arlt W, Society for Endocrinology Clinical Committee. SOCIETY FOR ENDOCRINOLOGY ENDOCRINE EMERGENCY GUIDANCE: Emergency management of acute adrenal insufficiency (adrenal crisis) in adult patients. Endocr Connect. 2016 Sep. 5 (5):G1-G3