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ICI-related adrenal insufficiency (primary or central) is a time-sensitive emergency when hypotension, hyponatremia, hyperkalemia, and hypoglycemia coexist. Do not delay therapy for lab confirmation. Administer stress-dose corticosteroids—hydrocortisone 100 mg IV bolus followed by 50 mg IV every 6 hours (or continuous infusion)—plus rapid isotonic fluids and dextrose as needed. Draw cortisol and ACTH first if it won’t delay treatment; cosyntropin testing can occur later. Hold the checkpoint inhibitor during the acute phase. If primary adrenal failure is confirmed, add mineralocorticoid (fludrocortisone) after stabilization. Thyroid replacement must NOT precede glucocorticoid replacement (Option A) because it can precipitate adrenal crisis. Waiting for labs (Option B) risks shock. Sympathomimetics (midodrine) without steroids (Option D) ignore the pathophysiology. APRNs should educate patients on sick-day rules, provide a steroid card/bracelet, and coordinate endocrinology follow-up and a slow steroid taper once improved, while reassessing whether/when to resume ICI based on grade and response.