Regarding Addison's disease and prevention of Addisonian crisis, which statement reflects correct guidance?

• A. You can take either hydrocortisone or fludrocortisone for replacement.
• B. You need to take your fludrocortisone 3 times a day to prevent a crisis.
• C. You need to increase salt in your diet, particularly during stressful situations.
• D. You need to decrease your dosages of glucocorticoids and mineralocorticoids during stressful situations.

Answer: (C)

In Addison’s disease, there’s a deficiency of both cortisol and aldosterone. The lack of aldosterone leads to salt wasting and low blood pressure, especially under stress. To help prevent an Addisonian crisis, increasing salt intake during stressful situations is advised because more sodium helps maintain fluid volume and blood pressure when mineralocorticoid activity is limited. This practical guidance directly addresses the body’s need to balance sodium and volume when the adrenal hormones are not adequately available.

Replacement therapy is more nuanced: glucocorticoid (like hydrocortisone) and mineralocorticoid (like fludrocortisone) replacements have distinct roles and aren’t simply interchangeable, and doses during stress are typically increased rather than decreased. Fludrocortisone is not normally given three times daily, and reducing steroid dosages during stress would raise the risk of crisis.