After bilateral adrenalectomy, what lifelong hormone replacement is required?

• A. Only glucocorticoids
• B. Only mineralocorticoids
• C. Both glucocorticoids and mineralocorticoids
• D. None

Answer: (C)

After removing both adrenal glands, the body can no longer produce cortisol (a glucocorticoid) or aldosterone (a mineralocorticoid). Because of this, lifelong replacement of both hormone classes is required. Glucocorticoid replacement prevents adrenal crisis and supports energy metabolism and vascular responsiveness. Mineralocorticoid replacement maintains sodium and water balance, as well as potassium excretion, helping to keep blood pressure stable. Without mineralocorticoid replacement, serious electrolyte disturbances and hypotension can occur. In practice, treatment often uses a glucocorticoid (such as hydrocortisone) for daily needs, plus a mineralocorticoid (such as fludrocortisone) to ensure mineralocorticoid activity. Patients also need education on increased dosing during illness or stress and not stopping therapy abruptly.