skip to main content

Abiraterone-associated mineralocorticoid excess — MSRA MCQ

Instant feedback + full explanation. One question, done properly.

HardProstate CancerAbiraterone-associated mineralocorticoid excessMSRA

A 72-year-old man with newly diagnosed high-risk metastatic hormone-sensitive prostate cancer started goserelin, abiraterone 1 g once daily and prednisolone 5 mg once daily 4 weeks ago. Before treatment, his blood pressure was 132/76 mmHg and potassium was 4.3 mmol/L. He reports good adherence to all treatment. At a planned oncology review, his blood pressure is 178/104 mmHg. He has gained 2.5 kg and has new bilateral ankle oedema. Potassium is 2.8 mmol/L; renal function and transaminases are unchanged. He has no chest pain, dyspnoea, palpitations or neurological symptoms. What is the most appropriate management of his systemic anticancer treatment now?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Withhold abiraterone, urgently correct the hypokalaemia and manage the hypertension and fluid retention, then restart only after toxicity resolves to grade 1 or baseline.

Explanation lettering: E = shown as A · A = shown as B · B = shown as D · D = shown as E

This is clinically significant abiraterone-related mineralocorticoid excess: new severe hypertension, potassium 2.8 mmol/L and fluid retention shortly after treatment initiation. Abiraterone inhibits CYP17, increasing mineralocorticoid activity; concomitant prednisolone reduces but does not eliminate this risk. The SmPC states that abiraterone should be withheld for grade 3 or greater hypertension, hypokalaemia or oedema, with appropriate medical management instituted. It should not be restarted until toxicity has improved to grade 1 or baseline. His androgen-deprivation therapy should continue while abiraterone is withheld. A is unsafe because severe concurrent hypokalaemia, hypertension and oedema require interruption of abiraterone rather than outpatient optimisation while exposure continues. B may appear mechanistically attractive because corticosteroid suppresses ACTH drive, but it does not replace withholding abiraterone in this severity of toxicity. C is premature: permanent discontinuation is not required if toxicity resolves and rechallenge is appropriate. D is incorrect because prednisolone mitigates, rather than causes, mineralocorticoid excess; stopping it may worsen the syndrome.

Reference: Abiraterone 500 mg film-coated tablets - Summary of Product Characteristics (2024) — https://www.medicines.org.uk/emc/product/15741/smpc Abiraterone (originator and generics) for treating newly diagnosed high-risk hormone-sensitive metastatic prostate cancer (19 November 2025) — https://www.nice.org.uk/guidance/ta1110/chapter/1-Recommendations