In adrenal crisis, what is the initial pharmacologic treatment in the ED?

• A. Steroids and aggressive IV fluids
• B. Antibiotics only
• C. Surgery
• D. Diuretics

Answer: (A)

Adrenal crisis is a life-threatening shortage of cortisol that leads to severe hypotension and volume depletion. The most important immediate actions in the ED are to restore circulating volume and replace cortisol. This means giving aggressive isotonic IV fluids to rapidly resuscitate and improve perfusion, paired with intravenous glucocorticoid therapy (usually hydrocortisone) to replace the missing hormone and stabilize vascular tone. Hydrocortisone provides both glucocorticoid and some mineralocorticoid effects, helping with sodium and water balance as the patient stabilizes. If the patient is hypoglycemic, start dextrose-containing fluids. Antibiotics or surgery aren’t the initial measures unless another condition demands them, and diuretics would worsen dehydration. Treating promptly with fluids and steroids buys time while further evaluation and management proceed.