What is a common precipitating factor for an adrenal crisis?

• A. High-dose glucocorticoids
• B. Eating a large meal
• C. Excessive exercise
• D. Abrupt withdrawal of glucocorticoids

Answer: (D)

Adrenal crisis occurs when the body cannot mount an adequate cortisol response during stress. Chronic use of glucocorticoids suppresses the hypothalamic-pituitary-adrenal axis, leading to adrenal atrophy. If glucocorticoids are stopped abruptly, the body loses its exogenous cortisol source and the atrophied adrenal glands can’t quickly resume production. Under stress from illness or surgery, this lack of cortisol leads to poor vascular tone, hypotension, shock, vomiting, abdominal pain, hypoglycemia, and electrolyte abnormalities.

The other options don’t fit as precipitating factors: continuing high-dose glucocorticoids maintains cortisol levels rather than causing deficiency; eating a large meal or excessive exercise aren’t typical triggers for adrenal crisis.