What is the guideline for using steroids in patients with acute adrenal insufficiency?

The guideline for using steroids in patients with acute adrenal insufficiency emphasizes the importance of administering intravenous fluids along with steroids, particularly hydrocortisone. This approach is crucial as it addresses both the immediate need for hormonal replacement and the management of the patient's hemodynamic status.

In acute adrenal insufficiency, the body's stress response is impaired due to inadequate cortisol production, which is vital for maintaining cardiovascular stability and fluid balance. Administering IV fluids helps to counteract hypotension and support circulation, while steroids, such as hydrocortisone, replenish the deficient adrenal hormones.

The ACTH test is not typically performed during an acute emergency situation because the priority is to stabilize the patient. In acute settings, there is no time to evaluate the adrenal gland's function before treating, hence the focus is on providing immediate treatment with IV fluids and steroids.

Using only hydrocortisone injections would not be sufficient without addressing fluid volume and hemodynamic support, making the combination of IV fluids and steroids the standard practice for managing acute adrenal crises.