Hydrocortisone should be started immediately adrenal insufficiency is consideredBMJ 1996; 313 doi: https://doi.org/10.1136/bmj.313.7054.427a (Published 17 August 1996) Cite this as: BMJ 1996;313:427
EDITOR,—The most important lesson to be learnt from the cases of Addison's disease reported by C M Brosnan and N F C Gowing is not stated.1 In any patient in whom addisonian crisis is suspected, serum should be saved for measurement of cortisol and adrenocorticotrophic hormone concentrations and treatment with intravenous hydrocortisone 100 mg should be started immediately. This should then be continued four hourly. The search for the precipitating cause can be concurrent.
Case 1 in Brosnan and Gowing's paper is a fairly classic case, and the biochemical abnormalities are suggestive of adrenal insufficiency. The authors state that the diagnosis of Addison's disease was considered, yet no treatment was started. I would hope that the lesson of the week is that, having considered the possibility of adrenal insufficiency, despite its non-specific presentation, you should treat it. Failure to do so has rapidly lethal results, as the case shows.
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