In suspected Addison's disease presenting with adrenal crisis, which glucocorticoid is preferred intravenously?

• A. Dexamethasone
• B. Methylprednisolone
• C. Prednisone
• D. Hydrocortisone

Answer: (D)

In an adrenal crisis you need both glucocorticoid and mineralocorticoid replacement right away. Hydrocortisone provides that dual action: it supplies the cortisol needed for the stress response and has significant mineralocorticoid activity to help with blood pressure, sodium, and potassium balance affected by aldosterone deficiency. That makes it the best choice for IV use in suspected Addisonian crisis.

Dexamethasone, while a potent glucocorticoid, lacks meaningful mineralocorticoid activity, so it won’t adequately address the aldosterone deficit. Prednisone is typically given orally and isn’t ideal for immediate IV management. Methylprednisolone is mainly a glucocorticoid with less mineralocorticoid effect than hydrocortisone, so it’s not as complete a substitute in this acute setting.