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Adrenal Crisis in Emergency Medicine Medication

  • Author: Kevin M Klauer, DO, EJD, FACEP; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
Updated: Oct 29, 2015

Medication Summary

One of the goals in treating adrenal insufficiency is glucocorticoid replacement.[7] Electrolyte and metabolic abnormalities, as well as hypovolemia, must also be corrected. In addition, address the event precipitating abrupt decompensation.



Class Summary

These agents are primarily used to correct glucocorticoid deficiencies. The drugs of choice are hydrocortisone, cortisone, and prednisone.

Hydrocortisone (Cortef, Solu-Cortef)


DOC because of mineralocorticoid activity and glucocorticoid effects.

Cortisone (Cortone Acetate)


Considered the DOC by some practitioners.

Prednisone (Deltasone, Liquid Pred)


Treats various diseases including adrenocortical insufficiency. Agent is inactive and must be metabolized to active metabolite prednisolone. Conversion may be impaired in patients with liver disease.

Dexamethasone (Decadron, AK-Dex, Alba-Dex, Dexone)


Alternative to hydrocortisone to avoid interference with testing of cortisol levels.

Fludrocortisone acetate (Florinef Acetate)


Partial replacement therapy for primary and secondary adrenocortical insufficiency.

Contributor Information and Disclosures

Kevin M Klauer, DO, EJD, FACEP Assistant Clinical Professor, Michigan State University College of Osteopathic Medicine; Chief Medical Officer, Emergency Medicine Physicians, Ltd; Director, Center for Emergency Medical Education; Medical Editor-in-Chief, ACEP Now; Former Editor-in-Chief, Emergency Physicians Monthly

Kevin M Klauer, DO, EJD, FACEP is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Howard A Bessen, MD Professor of Medicine, Department of Emergency Medicine, University of California, Los Angeles, David Geffen School of Medicine; Program Director, Harbor-UCLA Medical Center

Howard A Bessen, MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Chief Editor

Romesh Khardori, MD, PhD, FACP Professor of Endocrinology, Director of Training Program, Division of Endocrinology, Diabetes and Metabolism, Strelitz Diabetes and Endocrine Disorders Institute, Department of Internal Medicine, Eastern Virginia Medical School

Romesh Khardori, MD, PhD, FACP is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Physicians, American Diabetes Association, Endocrine Society

Disclosure: Nothing to disclose.

Additional Contributors

Erik D Schraga, MD Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates

Disclosure: Nothing to disclose.

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Regulation of the adrenal cortex.
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