A 28-year-old woman presents with a 2-week history of progressive fatigue, myalgias, and orthostatic lightheadedness. She was recently diagnosed with primary adrenal insufficiency (elevated ACTH, low baseline cortisol) and started on hydrocortisone 15 mg daily (divided doses) and fludrocortisone 0.1 mg daily. She reports good medication adherence. Vital signs show BP 98/62 mmHg (baseline 110/70 mmHg) and HR 102 bpm. Laboratory studies reveal: sodium 132 mEq/L (normal 136-145), potassium 5.2 mEq/L (normal 3.5-5.0), and cortisol 16 µg/dL measured 2 hours after her morning hydrocortisone dose. Which of the following is the most appropriate next step in management?
- A)Increase fludrocortisone to 0.2 mg daily
- B)Increase hydrocortisone to 20 mg dailyGABARITO
- C)Administer intravenous hydrocortisone 100 mg stat followed by continuous infusion
- D)Switch to dexamethasone 1.5 mg daily for superior glucocorticoid potency
- E)Measure 24-hour urinary free cortisol to assess for cortisol overproduction
Explicação
The patient has symptomatic inadequate glucocorticoid replacement despite compliance, as evidenced by persistent fatigue, weakness, and hypotension. The post-dose cortisol level of 16 µg/dL (target peak should be 15-20 µg/dL or higher depending on dosing sched... Ver explicação completa e trilha adaptativa →