Treatment of Acute Adrenal Crisis	

In an acute adrenal crisis, hydrocortisone hemisuccinate should be administered (100mg intravenously), together with saline to correct sodium losses and dextrose to treat hypoglycaemia. Intramuscular hydrocortisone should also be given (100mg at six- hour intervals) until the patient is able to take oral therapy, at which time hydrocortisone is given (40mg on waking, 20mg at 1800). 
When the patient is well, the oral dose is halved. Since intercurrent infections often precipitate the crisis, evidence for any infections should be actively sought and the appropriate antibiotic treatment given. It is, however, important to recognise that a pyrexia per se may occur in adrenal insufficiency without any superadded infection. 

See earlier:
• Glucocorticoid Replacement
• Mineralocorticoid Replacement