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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Last updated: May 4, 2010