What are the recommended management strategies for a patient with classic CAH presenting with adrenal crisis?

Recommended management strategies for a patient with classic congenital adrenal hyperplasia (CAH) presenting with an adrenal crisis include:

• Immediate administration of intravenous or intramuscular hydrocortisone without delay for diagnostic tests; the adult emergency dose is 100 mg, while paediatric doses vary by age and body surface area (e.g., 100 mg for children over 6 years, 50 mg for children 1–5 years, and 25 mg for infants under 1 year) ¹.
• Initiate rapid intravenous infusion of 0.9% sodium chloride (1 litre over 30 minutes) to correct hypovolaemia and electrolyte imbalances ².
• Frequent monitoring of vital signs including blood pressure and heart rate, as well as electrolyte and glucose levels, to guide ongoing management ².
• Emergency admission to hospital for specialist care and further management; do not delay transfer by performing diagnostic tests prior to treatment ¹.
• High-dose hydrocortisone provides sufficient mineralocorticoid effect during crisis; therefore, emergency fludrocortisone administration is not required ¹.
• Provide patients and carers with an emergency management plan including instructions for self-administration of hydrocortisone injections and sick-day rules to prevent crisis ².

These steps are critical to stabilise the patient and prevent life-threatening complications associated with adrenal crisis in CAH ¹,².