Professional and Linguistic Assessments Board (PLAB) Practice Exam

If a patient with Addison's disease contracts another virus, what is the management protocol?

1. Double methotrexate, keep fludrocortisone

2. Double hydro, keep fludrocortisone at same dose

3. Decrease hydro, increase fludrocortisone

4. Stop all medications

The correct answer is: Double hydro, keep fludrocortisone at same dose

For a patient with Addison's disease who contracts a viral infection, the management protocol involves adjusting their steroid replacement therapy to meet the increased physiological stress caused by the illness. Hydrocortisone is the most commonly used glucocorticoid in this context. When a patient with Addison's disease becomes ill, it is generally necessary to increase their glucocorticoid dosage because the body’s ability to produce cortisol is diminished due to the adrenal insufficiency. The doubling of hydrocortisone helps to mimic the body's normal stress response, ensuring that the patient receives adequate corticosteroid coverage to manage the stress of the illness. Maintaining the fludrocortisone at the same dosage is appropriate, as it helps to regulate electrolyte balance and does not typically require adjustment during illness unless there are specific indications. Therefore, the management of doubling hydrocortisone while keeping fludrocortisone at the same dose aligns with the best practice guidelines for handling acute stress in patients with adrenal insufficiency.