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Abiraterone Adrenal Crisis — SCE Medical Oncology MCQ

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ModerateUrological CancersAbiraterone Adrenal CrisisSCE Medical Oncology

A 58-year-old man with mCRPC on abiraterone develops fatigue and dizziness. His cortisol is very low at 50 nmol/L. He is taking prednisolone 5mg BD as prescribed. What has happened?

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Correct answer: A — Possible non-adherence to prednisolone OR concurrent illness increasing cortisol demand — abiraterone blocks cortisol synthesis and prednisolone replaces it; any disruption in prednisolone intake causes adrenal crisis; stress-dose steroids may be needed if unwell

Abiraterone blocks CYP17A1 (cortisol synthesis). Prednisolone 5mg BD replaces cortisol AND suppresses ACTH. If prednisolone is missed/vomited or patient is acutely unwell, adrenal crisis can occur. Patients should carry a steroid alert card. Sick-day rules: double prednisolone dose during intercurrent illness.

Reference: BNF Abiraterone; ESMO 2024 Prostate; Endocrine Society