In suspected adrenal crisis, which hormone replacement should be started immediately?

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

Answer: (B)

In an adrenal crisis, the immediate priority is to replace cortisol to support blood pressure and metabolic stability. Hydrocortisone is the preferred initial replacement because it provides both glucocorticoid activity and some mineralocorticoid activity, which helps restore vascular tone and electrolyte balance in shock from adrenal insufficiency. Administer IV hydrocortisone right away (for example, a 100 mg bolus followed by 50 mg IV every 6 hours or 200 mg per day by continuous infusion) while starting aggressive isotonic fluids and checking glucose levels. Fludrocortisone is used for long-term mineralocorticoid replacement, not acute management. While other steroids like dexamethasone or prednisone can replace glucocorticoids, they lack the same mineralocorticoid effect, making hydrocortisone the best immediate choice in suspected adrenal crisis.