Endocrine drugs: mineralocorticoid replacement: practice question

A Pharmacology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pharmacology · Endocrine drugs: mineralocorticoid replacement

Sample item

A woman with primary adrenal insufficiency on hydrocortisone and a stable dose has postural hypotension, serum sodium 128 mmol/L and potassium 5.8 mmol/L. Which additional drug is most appropriate?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Fludrocortisone

Primary adrenal failure destroys the zona glomerulosa as well as the fasciculata, so a mineralocorticoid is needed. Fludrocortisone restores sodium retention and potassium excretion, correcting hypotension and hyperkalaemia. More glucocorticoid does not replace aldosterone, and spironolactone would worsen hyperkalaemia.

Option by option

  • A. Prednisolone

    Prednisolone has little mineralocorticoid activity at replacement doses.

  • B. Spironolactone

    Spironolactone blocks aldosterone and would worsen hyperkalaemia.

  • C. Fludrocortisone (correct)

    Correct. It replaces the missing aldosterone effect on sodium and potassium.

  • D. Dexamethasone

    Dexamethasone has no mineralocorticoid activity and would not correct hyperkalaemia.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Pharmacology question

What is the answer to this Pharmacology question?

The best answer is C, Fludrocortisone. Primary adrenal failure destroys the zona glomerulosa as well as the fasciculata, so a mineralocorticoid is needed.

Why is "Prednisolone" not the answer?

Prednisolone has little mineralocorticoid activity at replacement doses.

Why is "Spironolactone" not the answer?

Spironolactone blocks aldosterone and would worsen hyperkalaemia.

Why is "Dexamethasone" not the answer?

Dexamethasone has no mineralocorticoid activity and would not correct hyperkalaemia.

What concept does this question test?

It tests Endocrine drugs: mineralocorticoid replacement in Pharmacology. Fludrocortisone restores sodium retention and potassium excretion, correcting hypotension and hyperkalaemia. More glucocorticoid does not replace aldosterone, and spironolactone would worsen hyperkalaemia.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Endocrine drugs: mineralocorticoid replacement?

Learn drugs as classes, then the exception in each class that an examiner would pick. Then use the flashcards and the other Pharmacology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.