A 63-year-old woman with a history of lung cancer presents with sudden onset severe back pain, hypotension (BP 85/50 mmHg), and altered mental status. She is found to have Na+ 128 mEq/L, K+ 6.2 mEq/L, and cortisol 4 µg/dL. Non-contrast CT abdomen shows bilateral adrenal masses with hemorrhage. Which of the following is the most appropriate immediate treatment?
- A)Start chemotherapy for metastatic disease
- B)Perform emergent adrenalectomy
- C)Start spironolactone for hyperkalemia
- D)Administer dexamethasone and schedule imaging
- E)Immediate IV hydrocortisone, fluid resuscitation, and vasopressorsGABARITO
Explicação
Acute adrenal hemorrhage (often from metastatic cancer) presents as adrenal crisis with shock, hyponatremia, hyperkalemia, and low cortisol. Immediate management requires IV hydrocortisone (100 mg bolus, then 50-100 mg q6-8h) PLUS aggressive fluid resuscitatio... Ver explicação completa e trilha adaptativa →