Professional and Linguistic Assessments Board (PLAB) Practice Exam

What is the recommended treatment for an adrenal crisis?

1. Intramuscular epinephrine

2. IV hydrocortisone

3. Oral steroids

4. Fluid challenge

The correct answer is: IV hydrocortisone

In the context of an adrenal crisis, the recommended treatment is intravenous hydrocortisone. An adrenal crisis occurs when there is an acute deficiency of cortisol, often triggered by stress, infection, or discontinuation of glucocorticoid treatment in patients with adrenal insufficiency. Hydrocortisone is a corticosteroid that mimics the action of cortisol in the body and is essential for restoring the body’s homeostasis during an acute crisis. Administering this medication intravenously allows for rapid absorption and action, which is critical in reversing the life-threatening symptoms associated with adrenal insufficiency, such as hypotension, hypoglycemia, and severe fatigue. Intramuscular epinephrine is primarily used in anaphylaxis and does not address the underlying deficiency of cortisol. Oral steroids, while important for long-term management of adrenal insufficiency, are not effective in a crisis situation due to their slower onset of action. A fluid challenge may be necessary to manage dehydration or shock, but it is not a specific treatment for the hormonal deficiency present in an adrenal crisis. Therefore, intravenous hydrocortisone is the appropriate and effective treatment in this emergency situation.