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