The initial treatment for Addisonian crisis includes which intervention?

The initial treatment for Addisonian crisis includes which intervention?

• A. Intravenous hydrocortisone with management of underlying cause
• B. Oral prednisone and bed rest
• C. Antibiotics alone
• D. Oral fluid replacement only

Answer: (A)

In an Addisonian crisis, the top priority is to replace the missing cortisol and restore perfusion while identifying the trigger. IV hydrocortisone is used immediately because it provides glucocorticoid replacement and has some mineralocorticoid activity to help stabilize blood pressure and electrolyte balance. This is paired with aggressive isotonic saline fluid resuscitation to correct dehydration and shock, plus prompt efforts to treat the underlying cause (such as infection or other stressors). Starting steroids right away is crucial; waiting for tests can delay life-saving treatment. Once stabilized, you’ll continue glucocorticoid therapy and address long-term mineralocorticoid needs and the underlying cause. Why the other options don’t fit: oral prednisone is too slow and not suitable for a crisis, and it doesn’t address the immediate need for IV replacement. Relying on antibiotics alone treats only a potential trigger without correcting the cortisol deficiency. Fluid replacement without steroid replacement fails to correct the fundamental hormonal deficiency causing hemodynamic instability.

In an Addisonian crisis, the top priority is to replace the missing cortisol and restore perfusion while identifying the trigger. IV hydrocortisone is used immediately because it provides glucocorticoid replacement and has some mineralocorticoid activity to help stabilize blood pressure and electrolyte balance. This is paired with aggressive isotonic saline fluid resuscitation to correct dehydration and shock, plus prompt efforts to treat the underlying cause (such as infection or other stressors).

Starting steroids right away is crucial; waiting for tests can delay life-saving treatment. Once stabilized, you’ll continue glucocorticoid therapy and address long-term mineralocorticoid needs and the underlying cause.

Why the other options don’t fit: oral prednisone is too slow and not suitable for a crisis, and it doesn’t address the immediate need for IV replacement. Relying on antibiotics alone treats only a potential trigger without correcting the cortisol deficiency. Fluid replacement without steroid replacement fails to correct the fundamental hormonal deficiency causing hemodynamic instability.