A patient with Addison’s disease presented with adrenal crisis. Drug of choice is:
Hydrocortisone, 100 mg intravenously every 8 hours, is the mainstay for treating adrenal insufficiency.
Alternatively, dexamethasone, 0.1 mg/kg every 8 hours, may be used without disruption of diagnostic testing.
Once diagnostic testing has been done, hydrocortisone is the drug of choice because it has both glucocorticoid and mineralocorticoid functions. Once patients are stable, the dose may be tapered gradually over 1–2 weeks.
Patients receiving less than 50 mg/d of hydrocortisone will likely need mineralocorticoid support as well. Fludrocortisone, 0.05–0.2 mg/d, is the drug of choice.
Ref: Huecker M.R., Danzl D.F. (2011). Chapter 43. Metabolic & Endocrine Emergencies. In R.L. Humphries, C. Stone (Eds), CURRENT Diagnosis & Treatment Emergency Medicine, 7e.