A fictional 55-year-old taking long-term glucocorticoids has vomiting, abdominal pain, hypotension, hyponatraemia and hypoglycaemia after missing medication for two days.
Listen for the assumption.
I planned to wait for the cortisol result before giving hydrocortisone so the diagnosis would remain clear.
What is the risk of prioritising diagnostic purity over immediate treatment?
Adrenal crisis can be fatal. Samples may be taken if they do not delay care, but treatment must start immediately when it is suspected.
Choose an answer below and reveal the reasoning to see consultant feedback at every checkpoint. The full consultant-led synthesis follows after all three decisions.
Go to the first decision ↓The picture develops.
- Persistent hypotension
- Low sodium and low glucose
- Medication record confirms chronic systemic glucocorticoid exposure
Commit before you reveal.
After you select an option, reveal the model reasoning and the consultant’s feedback.
Hear the senior team refine the plan.
The registrar tests the plan, the consultant synthesises the key principle, and the SHO confirms the safer next steps.
I will treat hypoglycaemia and shock, check electrolytes and seek the precipitating illness while hydrocortisone is given.
Good. Document exactly why crisis was suspected and what steroid exposure was identified, then involve endocrinology early.
The handover will include steroid history, omitted doses, treatment timing, haemodynamic response and prevention needs.
What must remain explicit.
- Do not delay emergency treatment for diagnostic confirmation.
- Follow local fluid and glucose protocols with repeated reassessment.
- Arrange endocrine advice and prevention planning after stabilisation.
Where reasoning fails.
- Waiting for cortisol
- Missing non-oral glucocorticoid exposure
- Discharging without sick-day and emergency-card planning
Suspected adrenal crisis after [steroid exposure/interruption], presenting with [features]. Hydrocortisone and resuscitation were given at [times], response is [trend], precipitant is [status], and endocrine input is [status].
Which routine medication-history questions would uncover hidden risk of adrenal suppression?