A 30-year-old woman with panhypopituitarism after pituitary apoplexy requires hormone replacement. The correct physiological order of hormone supplementation priority (most critical first) is:

• A Thyroid hormone → cortisol → gonadal steroids → GH
• B Gonadal steroids → cortisol → thyroid hormone → GH
• C GH → cortisol → thyroid hormone → gonadal steroids
• D Cortisol → thyroid hormone → gonadal steroids → GH ✓

Explanation

Cortisol replacement is the most critical because adrenal insufficiency is immediately life-threatening (Addisonian crisis). Thyroid hormone replacement is second priority; importantly, giving thyroid hormone before cortisol in a cortisol-deficient patient can precipitate an adrenal crisis by accelerating cortisol metabolism. Gonadal steroids are important for quality of life and bone health but are not immediately life-threatening. GH replacement, while beneficial, is the last priority.

Reference: Guyton & Hall, Textbook of Medical Physiology, 14th ed.

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Written and medically reviewed by the StethoPrep medical team.