Which finding would indicate the need to adjust hydrocortisone dosage in a patient with adrenal hypofunction?

• A. Fever
• B. Fluid retention
• C. Severe diarrhea
• D. Rapid weight gain

Answer: (B)

When managing adrenal hypofunction with hydrocortisone replacement, you adjust the dose based on signs of over- or under-replacement. Fluid retention signals too much steroid effect, particularly on mineralocorticoid activity, leading to edema and weight gain. This indicates the dose is too high and should be reduced to avoid complications from excess glucocorticoid/mineralocorticoid action.

Fever would point to infection or a stress response rather than a need to decrease steroid dose, and in illness you may actually need to adjust dosing upward to mimic the body’s stress response. Severe diarrhea can alter fluid and electrolyte balance and may affect management, but it doesn’t directly indicate overdosing of hydrocortisone. Rapid weight gain could accompany fluid retention, but the explicit sign of edema or fluid retention is the clearest cue to reduce the dose.