Management of Adrenal Crisis in Septic Shock

Clinical Assessment and Diagnosis

A patient with ulcerative colitis and fulminant relapse is at risk of adrenal crisis, as indicated by a history of cortisone use for adrenal disease, likely primary adrenal insufficiency 2
Laboratory findings consistent with adrenal crisis include hypoglycemia 4 and metabolic acidosis 5
Septic shock with fever and hypotension is a critical condition that requires immediate attention 3, 5

The Surviving Sepsis Campaign guidelines support using hydrocortisone in patients with septic shock who remain hemodynamically unstable despite adequate fluid resuscitation and vasopressor therapy 3, 5
Hydrocortisone 100mg IV bolus followed by 50mg IV every 6 hours is essential for replacing critical cortisol deficiency in a patient with likely adrenal insufficiency 2
Hydrocortisone addresses the underlying cause of shock and metabolic derangements 1

Fluid resuscitation should be initiated concurrently with hydrocortisone administration 3
Appropriate antibiotics for treating the underlying infection should be administered 3
Vasopressors may be needed if hypotension persists 5
Monitor electrolytes, glucose, and hemodynamic parameters closely 2
Once stabilized, taper hydrocortisone gradually rather than abruptly discontinuing 4, 1