An elderly male with a history of hypertension becomes unresponsive with signs of severe hypotension and hypoglycemia. Which condition should you suspect?

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This scenario points to an adrenal crisis (acute adrenal insufficiency). Cortisol helps keep blood pressure stable and supports glucose production during stress. When cortisol is lacking, blood vessels become less responsive to catecholamines, making hypotension more severe and hard to reverse with fluids alone. At the same time, cortisol deficiency impairs gluconeogenesis and glucose mobilization, so hypoglycemia can develop, especially in a stressed state like illness or trauma. Together, severe low blood pressure and low blood sugar in an elderly patient raise strong concern for adrenal crisis, which can be precipitated by illness, stress, or withdrawal from steroids.

While dehydration (hypovolemia) can cause low blood pressure, it doesn’t typically explain hypoglycemia. Sepsis can cause hypotension and sometimes hypoglycemia in advanced stages, but the combination of refractory hypotension with hypoglycemia is more characteristic of adrenal failure. Hypertension history doesn’t account for an acute collapse of blood pressure or glucose; these signs point toward adrenal insufficiency as the likely cause.

Immediate approach involves treating as adrenal crisis: secure the airway and breathing, start isotonic IV fluids, administer hydrocortisone empirically, and correct hypoglycemia as needed, with rapid endocrine evaluation.