Hypoadrenalism
First Things First (assess & treat for the following)
First Things First (assess & treat for the following)
First Things First (assess & treat for the following)
- Is pt in adrenal crisis or shock?
- Start stress-dose steroid replacement immediately.
- Hydrocortisone: first-line agent
- Dexamethasone: does not interfere w/ future cortisol assays
- If possible, draw random cortisol level before treatment.
- Consider drawing ACTH level as well.
- Short corticotrophin test can be postponed.
- Ensure adequate fluid resuscitation.
- Inotropic agents can be initiated but will be less effective in the absence of glucocorticoids.
- Does pt have electrolyte abnormalities that require immediate attention?
- Potassium >6.0 mEq/L
- Sodium < 120 mEq/L
- Glucose < 60 mg/dL
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