Adrenal Disorders USMLE Step 1 Practice Question
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?
Answer choices
- AIncrease fludrocortisone to 0.2 mg daily
- BIncrease hydrocortisone to 20 mg dailyCorrect answer
- CAdminister intravenous hydrocortisone 100 mg stat followed by continuous infusion
- DSwitch to dexamethasone 1.5 mg daily for superior glucocorticoid potency
- EMeasure 24-hour urinary free cortisol to assess for cortisol overproduction
- FCheck thyroid function and add levothyroxine if TSH is elevated
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