A 38-year-old previously healthy man presents to the emergency department with acute onset severe abdominal pain, nausea, and altered mental status. His wife reports he has been increasingly fatigued over the past month with progressive darkening of his skin. Physical examination reveals marked hyperpigmentation of his lips and buccal mucosa. Vital signs are: BP 78/48 mmHg, HR 122/min, RR 24/min, temperature 38.2°C. Laboratory studies show: sodium 118 mEq/L, potassium 6.8 mEq/L, glucose 54 mg/dL, cortisol 1.8 μg/dL (8 AM), ACTH 680 pg/mL. Abdominal imaging is unremarkable. Which of the following is the most appropriate initial management?

1. A)Administer intravenous hydrocortisone 100 mg immediately, followed by 50-100 mg every 6-8 hours, and initiate aggressive normal saline infusionGABARITO
2. B)Administer intravenous dexamethasone 4 mg stat, then 2 mg every 6 hours pending ACTH stimulation test results
3. C)Begin slow hypotonic fluid replacement and sodium restriction to avoid osmotic demyelination syndrome
4. D)Perform emergent abdominal CT with contrast and surgical consultation for suspected mesenteric ischemia
5. E)Initiate empiric broad-spectrum antibiotics and obtain blood cultures before administering any steroids