<![CDATA[Background: Adrenal crisis is an acute, life-threatening manifestation of cortisol deficiency that requires prompt recognition and treatment. Infection and sepsis are important precipitating factors, particularly in patients with underlying adrenal insufficiency. We report the successful multidisciplinary management of adrenal crisis complicated by septic shock and metabolic disturbances in an older patient.Case: A 64-year-old female patient with a diagnosis of adrenal crisis, septic shock, hyponatremia, recurrent hypoglycemia, and hospital-acquired pneumonia (HAP) is reported. Initial management included hydrocortisone administration as an exogenous glucocorticoid to address cortisol deficiency. Associated shock was managed with fluid resuscitation and vasopressors. Additionally, management of complications such as treating hypoglycemia with dextrose administration, correcting hyponatremia, and culture and antibiotic sensitivity testing were performed. Antibiotic therapy was administered in stages, starting with Ceftriaxone (empirical), escalation to Meropenem and Vancomycin, then de-escalation according to culture and sensitivity results. After 8 days of intensive care unit (ICU) treatment, the patient's condition improved, followed by 5 days of step-down care in the high care unit (HCU). The patient was then transferred to the general ward for 4 days. The patient was discharged with the tracheostomy still in place.Conclusion: Adrenal crisis in critically ill patients requires rapid glucocorticoid replacement together with simultaneous treatment of precipitating infection, shock, electrolyte abnormalities, and hypoglycemia. This case highlights the importance of coordinated multidisciplinary care, close physiologic monitoring, and culture-guided antimicrobial therapy in achieving clinical stabilization and recovery.]]>
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