A cortisol deficiency who is prescribed prednisone should be advised regarding work in hot outdoor conditions. Which statement is correct?

• A. You will need to learn how to rotate the injection sites.
• B. If you work outside in the heat, you may need another drug.
• C. You need to follow a diet with strict sodium restrictions.
• D. Take one tablet in the morning and two tablets at night.

Answer: (B)

When a cortisol-deficient person is on prednisone, you’re replacing glucocorticoid activity, but you also have to consider mineralocorticoid needs. Hot outdoor work creates physical stress and causes sweating with loss of salts and fluids. Prednisone provides limited mineralocorticoid effect, so in a hot environment the body may require additional support to maintain sodium balance and blood pressure. That often means adding another medication that provides mineralocorticoid activity or adjusting the overall replacement plan.

So the statement that you may need another drug if you’re working outside in the heat best reflects this reality: the extra support helps counteract salt and fluid losses and maintains hemodynamic stability during heat stress.

The other options don’t fit because rotating injection sites isn’t relevant to an oral glucocorticoid like prednisone, strict sodium restriction would worsen dehydration and electrolyte imbalance in this situation, and a fixed dosing split isn’t a standard or safe rule for managing adrenal insufficiency in the context of heat stress.