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Primary adrenal insufficiency — SCE Endocrinology MCQ

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HardAdrenalPrimary adrenal insufficiencySCE Endocrinology

A patient with primary adrenal insufficiency takes hydrocortisone and fludrocortisone. Blood pressure is low, postural symptoms persist, sodium is 132 mmol/L, potassium 5.2 mmol/L and plasma renin is markedly raised. Which adjustment is most appropriate?

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Correct answer: D — Increase fludrocortisone after checking adherence and salt intake

Persistent postural hypotension, hyponatraemia, hyperkalaemia and high renin indicate inadequate mineralocorticoid effect after adherence and intake are reviewed. Fludrocortisone should be titrated clinically with electrolytes and renin as supporting information; spironolactone would worsen the physiological deficit.

Reference: NICE NG243 recommendations for adrenal insufficiency (Published 28 August 2024): https://www.nice.org.uk/guidance/ng243/chapter/Recommendations; Society for Endocrinology emergency management of adrenal crisis (Current guidance, accessed 30 July 2026): https://www.endocrinology.org/adrenal-crisis