A 6-year-old girl presents to the Emergency Room with profound weakness, headache, high fever, and shaking chills for the past 12 hours. According to the child’s mother, the girl has been complaining of intermittent fatigue, weakness, decreased appetite, nausea, abdominal pain, and diarrhea for the past few weeks, but her symptoms suddenly worsened last night. Now she seems confused and disoriented and is difficult to arouse from sleep. On exam, she is pale, diaphoretic, and tachypneic, with a temperature of 40°C (104.5°F), BP of 60/36, and a pulse of 140. The physician notices some hyperpigmentation over her knuckles, elbows, knees, and mucous membranes (see figure) but the rest of her exam is normal. Laboratory testing reveals serum sodium of 127 mmol/L, plasma adrenocorticotropic hormone (ACTH) 224 pmol/L, and plasma cortisol of 62 nmol/L. 17-Hydroxyprogesterone and deoxycortisol levels are within normal limits. What is the most appropriate next step in this patient’s treatment?
A. Fludrocortisone
B. Growth hormone
C. Hydrocortisone
D. Infusion of isotonic NaCl
E. Levothyroxine
A. Fludrocortisone
B. Growth hormone
C. Hydrocortisone
D. Infusion of isotonic NaCl
E. Levothyroxine