Adrenal Emergencies Practice Questions

25 multiple-choice questions on Adrenal emergencies for paramedic and EMT students, from Chapter 24 (Endocrine Emergencies). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

25 practice questions

1. A child with meningococcal sepsis and spreading purpura has shock that does not respond to fluids. Bleeding into both adrenal glands is called:

   1. A. Cushing syndrome
   2. B. Waterhouse-Friderichsen
   3. C. Conn syndrome
   4. D. Sheehan syndrome after birth
   Show answer

   Answer: B. Waterhouse-Friderichsen

   In fulminant meningococcemia, bilateral adrenal hemorrhage causes acute adrenal failure and refractory shock. Hydrocortisone may be needed along with antibiotics and fluids.

2. The most common cause of adrenal insufficiency in EMS patients is:

   1. A. A tumor of the pituitary gland
   2. B. Tuberculosis of both adrenals
   3. C. Bleeding into both adrenal glands
   4. D. Abruptly stopping steroids
   Show answer

   Answer: D. Abruptly stopping steroids

   Abruptly stopping steroids is the classic trigger: long-term prednisone or other glucocorticoids suppress the body's own cortisol production, so stopping them suddenly, or facing extra stress while on them, can trigger adrenal crisis; this is the most common cause of adrenal insufficiency seen in the field. A pituitary tumor can cause secondary adrenal insufficiency but is far less common. Tuberculosis of both adrenals was once a leading cause and still is in some parts of the world, but it is uncommon in US EMS patients. Bleeding into both adrenal glands, as in overwhelming sepsis or anticoagulation, is a rare, acute cause.

3. Adrenal crisis is often misdiagnosed at first as:

   1. A. Gastroenteritis or sepsis
   2. B. A panic attack
   3. C. A severe migraine headache
   4. D. Heart failure
   Show answer

   Answer: A. Gastroenteritis or sepsis

   Vomiting, abdominal pain, fever, weakness, and shock in adrenal crisis closely resemble gastroenteritis or sepsis. Asking about steroid use or adrenal disease is key. Panic attacks, migraine, and heart failure do not cause this mix of vomiting, fever, and shock.

4. Chronic Addison disease may cause skin that is:

   1. A. Pale and yellow-tinged
   2. B. Bright red and flushed
   3. C. Bluish
   4. D. Darkened or bronze
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   Answer: D. Darkened or bronze

   High ACTH stimulates pigment cells, darkening the skin, gums, and skin creases.

5. A patient who takes prednisone 20 mg daily for a year has major injuries from a crash. You should:

   1. A. Ignore it; steroids do not matter
   2. B. Report it; he may need stress steroids
   3. C. Give extra prednisone by mouth now
   4. D. Stop all of his steroids until discharge
   Show answer

   Answer: B. Report it; he may need stress steroids

   Long-term steroid use suppresses the adrenal axis, so major trauma can precipitate adrenal crisis. Report it so the trauma team can give stress-dose hydrocortisone.

6. In a patient with Addison disease, which event most often triggers adrenal crisis?

   1. A. A mild headache
   2. B. Eating a large meal
   3. C. A GI illness with vomiting
   4. D. Going to sleep early at night
   Show answer

   Answer: C. A GI illness with vomiting

   Vomiting and diarrhea prevent absorption of oral hydrocortisone while illness raises cortisol needs, making GI illness the most common trigger. Patients should switch to injectable hydrocortisone.

7. For a child in adrenal crisis, IV hydrocortisone is typically dosed at about:

   1. A. About 2 mg/kg, max 100 mg
   2. B. 0.01 mg/kg
   3. C. 50 mg/kg
   4. D. 1 gram for a child of any age
   Show answer

   Answer: A. About 2 mg/kg, max 100 mg

   Pediatric guidance uses about 50 to 100 mg/m2, roughly 2 mg/kg, up to the adult dose of 100 mg. Give it promptly, along with fluids and dextrose as needed.

8. A known Addison patient hands you an emergency hydrocortisone injection kit. You should:

   1. A. Ignore it and transport the patient
   2. B. Help give it per protocol
   3. C. Give insulin instead
   4. D. Wait for the hospital
   Show answer

   Answer: B. Help give it per protocol

   Many protocols allow EMS to give a patient's own hydrocortisone. Delays in crisis can be fatal.

9. Addison disease often occurs together with other autoimmune diseases such as:

   1. A. Osteoarthritis and gout
   2. B. Asthma and eczema
   3. C. Type 1 diabetes and thyroid disease
   4. D. Kidney stones and also gallstones in adults
   Show answer

   Answer: C. Type 1 diabetes and thyroid disease

   Autoimmune adrenal insufficiency is frequently part of autoimmune polyglandular syndromes with type 1 diabetes and autoimmune thyroid disease. A type 1 diabetic with new frequent lows may have developed Addison disease.

10. The most common cause of Cushing syndrome is:

    1. A. An adrenal gland tumor
    2. B. A lung cancer
    3. C. A tumor of the pituitary gland
    4. D. Long-term steroid medicine
    Show answer

    Answer: D. Long-term steroid medicine

    Exogenous glucocorticoids, such as prednisone for asthma or arthritis, cause most cases. Endogenous causes, mainly ACTH-secreting pituitary tumors, are much rarer.

11. Signs of Cushing syndrome include:

    1. A. Weight loss and darkened skin
    2. B. Moon face and central obesity
    3. C. Bulging eyes and tremor
    4. D. Hypothermia and bradycardia
    Show answer

    Answer: B. Moon face and central obesity

    Cortisol excess redistributes fat to the face, trunk, and upper back, and thins the skin and bones.

12. Patients with Cushing syndrome are at increased risk of:

    1. A. Infection, fractures, high glucose
    2. B. Low blood pressure and low glucose
    3. C. Hypothyroidism
    4. D. Salt craving and bronze, darkened skin
    Show answer

    Answer: A. Infection, fractures, high glucose

    Excess cortisol suppresses immunity (infection), weakens bone (osteoporotic fractures), and raises blood glucose and blood pressure. Low blood pressure and low glucose are the opposite pattern and fit adrenal insufficiency. Hypothyroidism is not a typical result of Cushing syndrome. Salt craving and bronze, darkened skin are signs of Addison disease, where cortisol is lacking and ACTH is high.

13. Pheochromocytoma attacks are sometimes misdiagnosed as:

    1. A. Migraine with aura only
    2. B. Appendicitis
    3. C. Seasonal allergies
    4. D. Panic attacks
    Show answer

    Answer: D. Panic attacks

    Sudden episodes of pounding headache, sweating, palpitations, and anxiety resemble panic attacks. Very high blood pressure during episodes is a clue to a catecholamine-secreting tumor.

14. Unlike Addison disease, adrenal insufficiency caused by pituitary failure usually does not cause:

    1. A. Low blood pressure
    2. B. Fatigue and weakness
    3. C. High potassium or dark skin
    4. D. Low blood sugar levels in illness
    Show answer

    Answer: C. High potassium or dark skin

    Pituitary (secondary) adrenal insufficiency lacks ACTH but preserves aldosterone, so potassium is usually normal, and without high ACTH there is no hyperpigmentation. Low cortisol still causes hypotension and hypoglycemia.

15. Why should beta blockers alone be avoided in suspected pheochromocytoma?

    1. A. They cause hypoglycemia
    2. B. They block insulin
    3. C. Unopposed alpha raises BP
    4. D. They cause severe bradycardia only
    Show answer

    Answer: C. Unopposed alpha raises BP

    Blocking beta receptors leaves alpha vasoconstriction unopposed, worsening hypertension. Alpha blockade is given first in the hospital.

16. A single dose of etomidate given for intubation can briefly:

    1. A. Stimulate cortisol release
    2. B. Suppress adrenal cortisol production
    3. C. Suppress thyroid hormone output
    4. D. Cause lasting low blood sugar for hours
    Show answer

    Answer: B. Suppress adrenal cortisol production

    Etomidate inhibits an enzyme needed for cortisol synthesis, suppressing adrenal function for hours. Its clinical importance in sepsis is debated, but it is relevant in known adrenal insufficiency. It blocks rather than stimulates cortisol, and it does not affect thyroid output or cause lasting hypoglycemia.

17. A child with congenital adrenal hyperplasia is vomiting and lethargic. You should suspect:

    1. A. Adrenal crisis
    2. B. Simple gastroenteritis only
    3. C. Normal fatigue
    4. D. Appendicitis only
    Show answer

    Answer: A. Adrenal crisis

    Children with this condition cannot make cortisol and may go into crisis during illness.

18. Along with hydrocortisone, a hypotensive patient in adrenal crisis usually needs:

    1. A. Fluid restriction
    2. B. A diuretic
    3. C. Potassium supplements given by mouth
    4. D. IV isotonic saline boluses
    Show answer

    Answer: D. IV isotonic saline boluses

    Adrenal crisis causes salt and water loss, so isotonic saline is given (often 1 L quickly in adults) with dextrose if glucose is low. Potassium is often high, not low.

19. Hyperaldosteronism typically causes:

    1. A. Hypotension and high potassium
    2. B. Hypertension and low potassium
    3. C. Low glucose
    4. D. High calcium
    Show answer

    Answer: B. Hypertension and low potassium

    Excess aldosterone retains sodium and water and wastes potassium.

20. Besides pills, which steroid exposure can also suppress the adrenal glands?

    1. A. Steroid-free nasal saline spray
    2. B. Topical antibiotic creams
    3. C. High-dose inhaled or injected steroids
    4. D. Oral iron supplements taken with meals
    Show answer

    Answer: C. High-dose inhaled or injected steroids

    High-dose inhaled, injected joint, and potent topical steroids can be absorbed enough to suppress the adrenal axis. Ask about all steroid routes in a critically ill patient.

21. In refractory septic shock, the hospital may give hydrocortisone mainly because it:

    1. A. Can improve response to vasopressors
    2. B. Kills bacteria directly
    3. C. Replaces lost blood volume
    4. D. Lowers the risk of stress ulcers in shock
    Show answer

    Answer: A. Can improve response to vasopressors

    Surviving Sepsis guidelines suggest IV hydrocortisone for adults with septic shock needing ongoing vasopressors, as it speeds shock reversal. It does not treat infection. Steroids do not replace volume, and they tend to raise rather than lower stress ulcer risk.

22. A patient on long-term high-dose steroids has new groin pain without injury. You should consider:

    1. A. A pulled hamstring
    2. B. An inguinal hernia
    3. C. Normal aging of the joint
    4. D. Bone death of the hip
    Show answer

    Answer: D. Bone death of the hip

    Avascular necrosis of the femoral head is a known complication of long-term steroids, causing groin or hip pain and eventual collapse of the joint.

23. Skin findings in Cushing syndrome include:

    1. A. Bronze, darkened skin creases
    2. B. Yellow, jaundiced skin
    3. C. Raised, itchy hives
    4. D. Purple striae, bruising
    Show answer

    Answer: D. Purple striae, bruising

    Thin, fragile skin and wide purple striae are common.

24. Pheochromocytoma attacks may be triggered by:

    1. A. Resting quietly
    2. B. Fasting for a few hours
    3. C. Stress or exertion
    4. D. Drinking cold water
    Show answer

    Answer: C. Stress or exertion

    Physical pressure on the tumor, stress, and some medications can trigger catecholamine release. Quiet rest and short fasts are not typical triggers.

25. A patient with sudden severe hypertension, headache, and sweating has no drug history. Along with stroke and ACS, you should consider:

    1. A. Pheochromocytoma
    2. B. Addison disease crisis
    3. C. Hypothyroidism
    4. D. Hypoglycemia
    Show answer

    Answer: A. Pheochromocytoma

    Episodes of catecholamine excess can mimic stimulant overdose. Report the pattern to the hospital.