For patients with known adrenal insufficiency, what should you do?

• A. Administer the Patient's Own Solu-Cortef (Hydrocortisone) As Prescribed
• B. Withhold Steroids
• C. Administer Dexamethasone
• D. Administer Prednisone

Answer: (A)

In this situation, the priority is to replace the steroids promptly in someone with known adrenal insufficiency who is under stress or in crisis. Administer the patient’s own hydrocortisone (Solu-Cortef) as prescribed. Hydrocortisone provides both glucocorticoid and mineralocorticoid effects, which are essential for stabilizing blood pressure, improving vascular responsiveness, and correcting metabolic stress during an adrenal crisis. Giving the prescribed hydrocortisone parenterally (if the patient cannot take it by mouth) helps ensure rapid, effective replacement.

Choosing a different steroid isn’t ideal in this emergency. Dexamethasone lacks mineralocorticoid activity, which is important in adrenal crisis, and prednisone is oral with a slower onset—not as reliable in acute deterioration. Withholding steroids in known adrenal insufficiency during a stress response can worsen shock and outcomes, so the patient’s own prescribed hydrocortisone should be given without delay and continued per protocol.