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Exercise economy — MRCP Part 1 MCQ

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HardExercise PhysiologyExercise economyMRCP Part 1

A patient develops chronic ACTH deficiency after pituitary surgery. Morning cortisol and dynamic testing confirm secondary adrenal insufficiency. Renin, potassium and blood pressure are normal. What long-term replacement regimen is appropriate?

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Correct answer: E — Glucocorticoid replacement without routine fludrocortisone

The best answer is “Glucocorticoid replacement without routine fludrocortisone”. Secondary adrenal insufficiency reflects deficient ACTH, while the renin–angiotensin system usually preserves aldosterone secretion. NICE therefore offers glucocorticoid replacement alone, unlike primary adrenal insufficiency where mineralocorticoid replacement may be required. Fludrocortisone can cause hypertension and hypokalaemia without benefit here, and neither desmopressin nor a mineralocorticoid antagonist replaces cortisol.

Reference: NICE NG243, Adrenal insufficiency: identification and management: https://www.nice.org.uk/guidance/ng243/chapter/Recommendations