Which medication acts as a mineralocorticoid replacement in Addison's disease?

Which medication acts as a mineralocorticoid replacement in Addison's disease?

• A. Hydrocortisone
• B. Fludrocortisone
• C. Dexamethasone
• D. Prednisone

Answer: (B)

In Addison’s disease, there is a deficiency of aldosterone, which leads to salt wasting, low blood pressure, and electrolyte imbalances. The medication that provides a dedicated mineralocorticoid effect is fludrocortisone. It acts like aldosterone at the distal nephron, promoting sodium reabsorption and potassium excretion to help restore circulating volume and maintain electrolytes and blood pressure. In practice, fludrocortisone is often used alongside a glucocorticoid (such as hydrocortisone) to address cortisol deficiency; hydrocortisone has some mineralocorticoid activity but is mainly for glucocorticoid replacement. The other options are primarily glucocorticoids with little mineralocorticoid effect, so they don’t serve well as mineralocorticoid replacement. Monitoring focuses on electrolytes, blood pressure, weight, and signs of fluid balance, with plasma renin activity helping fine-tune the dose.

In Addison’s disease, there is a deficiency of aldosterone, which leads to salt wasting, low blood pressure, and electrolyte imbalances. The medication that provides a dedicated mineralocorticoid effect is fludrocortisone. It acts like aldosterone at the distal nephron, promoting sodium reabsorption and potassium excretion to help restore circulating volume and maintain electrolytes and blood pressure. In practice, fludrocortisone is often used alongside a glucocorticoid (such as hydrocortisone) to address cortisol deficiency; hydrocortisone has some mineralocorticoid activity but is mainly for glucocorticoid replacement. The other options are primarily glucocorticoids with little mineralocorticoid effect, so they don’t serve well as mineralocorticoid replacement. Monitoring focuses on electrolytes, blood pressure, weight, and signs of fluid balance, with plasma renin activity helping fine-tune the dose.