A 63-year-old man with Addison's disease presents with vomiting, abdominal pain, low blood pressure, and dehydration following a chest infection. Which medicine should be administered urgently?

A 63-year-old man with Addison's disease presents with vomiting, abdominal pain, low blood pressure, and dehydration following a chest infection. Which medicine should be administered urgently?

• A. Dexamethasone
• B. Hydrocortisone
• C. Fludrocortisone
• D. Hydralazine

Answer: (B)

In an Addisonian crisis, the priority is rapid cortisol replacement to restore blood pressure and organ perfusion. Hydrocortisone is the best choice because it provides both glucocorticoid and mineralocorticoid effects. The acute deficiency of cortisol drives shock and poor vascular tone, and the mineralocorticoid activity of hydrocortisone helps with salt and water retention to support blood pressure. Dexamethasone, while a strong glucocorticoid, has little mineralocorticoid activity, so it’s less ideal for correcting the sudden mineralocorticoid deficiency seen in adrenal crisis. Fludrocortisone is mainly a chronic mineralocorticoid replace­ment and isn’t sufficient on its own for an acute crisis. Hydralazine would worsen the hypotension and is not appropriate. In this scenario, administer intravenous hydrocortisone immediately (alongside aggressive IV fluids) to stabilize the patient, then continue stress-dose steroids and treat the underlying infection.

In an Addisonian crisis, the priority is rapid cortisol replacement to restore blood pressure and organ perfusion. Hydrocortisone is the best choice because it provides both glucocorticoid and mineralocorticoid effects. The acute deficiency of cortisol drives shock and poor vascular tone, and the mineralocorticoid activity of hydrocortisone helps with salt and water retention to support blood pressure.

Dexamethasone, while a strong glucocorticoid, has little mineralocorticoid activity, so it’s less ideal for correcting the sudden mineralocorticoid deficiency seen in adrenal crisis. Fludrocortisone is mainly a chronic mineralocorticoid replace­ment and isn’t sufficient on its own for an acute crisis. Hydralazine would worsen the hypotension and is not appropriate.

In this scenario, administer intravenous hydrocortisone immediately (alongside aggressive IV fluids) to stabilize the patient, then continue stress-dose steroids and treat the underlying infection.