Complications and emergencies: perioperative adrenal crisis: practice question

A Anaesthesia question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Anaesthesia · Complications and emergencies: perioperative adrenal crisis

Sample item

A woman on long-term oral prednisolone for rheumatoid arthritis, who received no perioperative steroid cover, becomes profoundly hypotensive during a hip replacement despite fluids and phenylephrine. Serum sodium is 126 mmol/L and glucose 58 mg/dL. Which drug is the immediate treatment?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Intravenous hydrocortisone

Long-term steroid therapy suppresses the hypothalamic-pituitary-adrenal axis, so surgical stress can precipitate adrenal crisis with refractory hypotension, hyponatraemia and hypoglycaemia. Treatment is immediate intravenous hydrocortisone, usually 100 mg, with fluid resuscitation and glucose, without waiting for confirmatory tests.

Option by option

  • A. A noradrenaline infusion alone

    Vasopressors alone do not correct the cortisol deficiency, and the shock remains refractory.

  • B. Intravenous hydrocortisone (correct)

    Correct. Hydrocortisone replaces the missing cortisol and restores vascular responsiveness to catecholamines.

  • C. Oral fludrocortisone alone

    Oral fludrocortisone is slow, cannot be absorbed reliably in shock and does not replace glucocorticoid.

  • D. Intravenous levothyroxine with fluids

    Thyroid hormone treats myxoedema, which does not explain the steroid history, hypoglycaemia and hyponatraemia with shock.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Anaesthesia question

What is the answer to this Anaesthesia question?

The best answer is B, Intravenous hydrocortisone. Long-term steroid therapy suppresses the hypothalamic-pituitary-adrenal axis, so surgical stress can precipitate adrenal crisis with refractory hypotension, hyponatraemia and hypoglycaemia.

Why is "A noradrenaline infusion alone" not the answer?

Vasopressors alone do not correct the cortisol deficiency, and the shock remains refractory.

Why is "Oral fludrocortisone alone" not the answer?

Oral fludrocortisone is slow, cannot be absorbed reliably in shock and does not replace glucocorticoid.

Why is "Intravenous levothyroxine with fluids" not the answer?

Thyroid hormone treats myxoedema, which does not explain the steroid history, hypoglycaemia and hyponatraemia with shock.

What concept does this question test?

It tests Complications and emergencies: perioperative adrenal crisis in Anaesthesia. Treatment is immediate intravenous hydrocortisone, usually 100 mg, with fluid resuscitation and glucose, without waiting for confirmatory tests.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Complications and emergencies: perioperative adrenal crisis?

Make a table of each agent, its key advantage and its main side effect. Then use the flashcards and the other Anaesthesia questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.