Adrenal insufficiency and adrenal crisis — structured clinical encounter

Recognition and immediate action

The candidate recognises the full primary picture: the hyperpigmentation of the palmar creases, gum margins and old scars, the postural hypotension, the weight loss, and the hyponatraemia with hyperkalaemia and hypoglycaemia. The first action is empiric: 10 to 20 mL per kg of 0.9% saline to perfusion, intravenous dextrose for the hypoglycaemia, and parenteral hydrocortisone 50 to 100 mg stat then 50 to 100 mg per square metre per 24 hours, with cultures and antibiotics because sepsis coexists. [4]