After reviewing inpatient assignments, which patient should be assessed first?

After reviewing inpatient assignments, which patient should be assessed first?

• A. A patient with Cushing disease who just returned to the unit after a bilateral adrenalectomy.
• B. A patient with Conn syndrome who experiences tremors.
• C. A patient with adrenal insufficiency who is euvolemic.
• D. A patient with hyperaldosteronism who has a mild hypertension.

Answer: (A)

The most urgent concern is the patient who recently returned after bilateral adrenalectomy for Cushing disease. Removing both adrenal glands leaves the body without endogenous cortisol and aldosterone, so they are at high risk for acute adrenal insufficiency (adrenal crisis). This can cause sudden hypotension, tachycardia, confusion, and electrolyte disturbances (hyponatremia, hyperkalemia), and it can be life-threatening if not promptly recognized and treated with appropriate steroid replacement and fluid/electrolyte management. The other scenarios may involve important issues—tremors from hypokalemia in hyperaldosteronism, euvolemia in adrenal insufficiency, or mild hypertension—but they do not present an immediate threat to stability in the same way as a post-adrenalectomy patient who needs guaranteed steroid support and close monitoring for signs of crisis.

The most urgent concern is the patient who recently returned after bilateral adrenalectomy for Cushing disease. Removing both adrenal glands leaves the body without endogenous cortisol and aldosterone, so they are at high risk for acute adrenal insufficiency (adrenal crisis). This can cause sudden hypotension, tachycardia, confusion, and electrolyte disturbances (hyponatremia, hyperkalemia), and it can be life-threatening if not promptly recognized and treated with appropriate steroid replacement and fluid/electrolyte management.

The other scenarios may involve important issues—tremors from hypokalemia in hyperaldosteronism, euvolemia in adrenal insufficiency, or mild hypertension—but they do not present an immediate threat to stability in the same way as a post-adrenalectomy patient who needs guaranteed steroid support and close monitoring for signs of crisis.