Which electrolyte change may accompany an acute primary adrenal crisis due to low cortisol?

• A. Hyperglycemia
• B. Hyperkalemia
• C. Hypoglycemia
• D. Hypercalcemia

Answer: (C)

Low cortisol during an acute primary adrenal crisis disrupts how the body maintains blood glucose. Cortisol stimulates hepatic gluconeogenesis and helps mobilize glucose during stress, while also opposing insulin’s effects. When cortisol is deficient, the liver can’t produce enough glucose and tissues take up glucose more readily, so blood sugar falls—producing hypoglycemia. This metabolic consequence is a prominent feature of adrenal crisis, especially in fasting or ill patients. While electrolyte abnormalities like hyponatremia and hyperkalemia are also seen in primary adrenal failure due to aldosterone deficiency and shifts driven by ADH, the direct glucose-regulating role of cortisol makes hypoglycemia the most characteristic answer in this context.