Step 2 UWorld Self-Assessment (UWSA) 2 Practice Exam

In suspected adrenal crisis the most important step is rapid replacement of both cortisol and volume. Giving hydrocortisone IV provides the needed glucocorticoid effect to restore vascular tone and the mineralocorticoid effect that helps with salt and water balance, while aggressive IV fluids correct the profound volume depletion and hypotension that this crisis causes. Starting with an IV hydrocortisone bolus (and continuing with a steady IV dose) alongside isotonic saline is the cornerstone of initial management. Oral therapy isn’t reliable in this emergency because the patient may be vomiting, unable to swallow, or not absorbing adequately. While vasopressors may be needed if shock persists, they don’t replace the essential steroid deficiency, so they’re adjuncts—not substitutes—for steroids. Diuretics and aggressive electrolyte correction without steroids would worsen intravascular volume depletion and electrolyte disturbances.