A patient whose Addison’s disease has been well-controlled on prednisone 20 mg daily and fludrocortisone (Florinef) 0.1 mg daily now has hypertension that is suboptimally controlled on two antihypertensive medications. Can I lower the dose of fludrocortisone—or even discontinue it entirely?
—Fadi Jabr, MD, Florence, Ore.
There are several ways of treating essential hypertension in patients with Addison’s disease. As opposed to the usual Addisonian patient who is allowed liberal salt intake, those with hypertension should restrict their dietary sodium. And while the fludrocortisone can be decreased to 0.05 mg/day, it cannot be stopped entirely because all patients with primary adrenal insufficiency need some mineralocorticoid replacement to avoid volume depletion and hyperkalemia. In addition, this patient’s prednisone dose can probably be decreased to 5-7.5 mg/day.
—Susan Kashaf, MD, MPH (116-13)