In the ED, a patient presents with hypertension, fatigue, and a 3-day history of weight loss and vomiting. A crisis is suspected. Which question is a priority?

In the ED, a patient presents with hypertension, fatigue, and a 3-day history of weight loss and vomiting. A crisis is suspected. Which question is a priority?

• A. Have you recently been on steroids or pain medication?
• B. Do you have a history of diabetes?
• C. Are you allergic to penicillin?
• D. Do you smoke?

Answer: (A)

The key idea is that adrenal crisis is often triggered or revealed by recent changes in glucocorticoid exposure. Asking whether the patient has recently been on steroids or pain medications is essential because exogenous steroid use can suppress the body's own cortisol production; in a stressful situation or with illness, this suppression can precipitate an acute adrenal crisis. Identifying recent steroid exposure helps you recognize that the crisis may be due to exogenous steroid withdrawal or insufficient dosing, which directly guides urgent management with stress-dose glucocorticoids (for example, IV hydrocortisone) and aggressive fluid resuscitation. The other questions are less directly tied to the immediate crisis mechanism: diabetes history isn’t as actionable in the moment, penicillin allergy and smoking don’t address the acute adrenal insufficiency risk.

The key idea is that adrenal crisis is often triggered or revealed by recent changes in glucocorticoid exposure. Asking whether the patient has recently been on steroids or pain medications is essential because exogenous steroid use can suppress the body's own cortisol production; in a stressful situation or with illness, this suppression can precipitate an acute adrenal crisis. Identifying recent steroid exposure helps you recognize that the crisis may be due to exogenous steroid withdrawal or insufficient dosing, which directly guides urgent management with stress-dose glucocorticoids (for example, IV hydrocortisone) and aggressive fluid resuscitation. The other questions are less directly tied to the immediate crisis mechanism: diabetes history isn’t as actionable in the moment, penicillin allergy and smoking don’t address the acute adrenal insufficiency risk.