What is the next step in managing a patient with Addison's disease and low blood pressure?

In managing a patient with Addison's disease who presents with low blood pressure, initiating a mineralocorticoid is a crucial step. Addison's disease is characterized by insufficient production of adrenal hormones, particularly cortisol and aldosterone. Low blood pressure in these patients often results from a deficiency in aldosterone, which is responsible for sodium retention, potassium excretion, and water retention—mechanisms that help maintain blood pressure.

When a patient exhibits hypotension, it is indicative of an acute adrenal crisis or inadequate management of their condition. By beginning a mineralocorticoid, such as fludrocortisone, the clinician addresses the underlying deficiency in aldosterone, thereby promoting sodium retention and fluid balance. This approach not only helps stabilize blood pressure but also corrects the electrolyte imbalances that may accompany adrenal insufficiency.

Increasing the dose of prednisone, while it may help address cortisol deficiency, does not directly address the mineralocorticoid deficiency that is often the cause of low blood pressure in these patients. Scheduling a follow-up for reassessment might be appropriate for chronic management but does not provide the immediate intervention needed for low blood pressure. Referring to an endocrinologist may be important for ongoing management, but the immediate intervention for a patient in this