Which glucocorticoid is given intravenously in adrenal crisis?

• A. Dexamethasone
• B. Hydrocortisone
• C. Prednisone
• D. Methylprednisolone

Answer: (B)

In adrenal crisis, the priority is rapid, physiologic glucocorticoid replacement that also provides mineralocorticoid activity to support blood pressure and electrolyte balance. Hydrocortisone fits this need because it has both glucocorticoid and meaningful mineralocorticoid effects. For acute management, give a 100 mg IV bolus of hydrocortisone, then 50 mg IV every 6 hours or a continuous infusion (about 200 mg over 24 hours), and plan to switch to oral hydrocortisone as the patient stabilizes. Other steroids lack mineralocorticoid activity (for example, dexamethasone is potent glucocorticoid but has little mineralocorticoid effect), or require oral administration (prednisone), or are less ideal for rapid replacement despite IV availability (methylprednisolone). Hydrocortisone thus provides the most physiologic replacement in adrenal crisis.