In myxedema coma, which additional therapy should be considered due to potential adrenal insufficiency?

• A. Dexamethasone
• B. Hydrocortisone
• C. Prednisone
• D. Fludrocortisone

Answer: (B)

Adrenal function can be compromised in myxedema coma, and starting thyroid hormone replacement increases metabolic demand. If the adrenal axis is insufficient, a crisis can be triggered unless glucocorticoid support is given. Hydrocortisone is preferred because it provides both glucocorticoid and mineralocorticoid activity, helping with stress-related cortisol needs and supporting blood pressure and electrolyte balance in the acute setting. In contrast, dexamethasone, while a potent glucocorticoid, lacks mineralocorticoid activity and can interfere with certain adrenal tests; prednisone is a glucocorticoid but is slower to act and may not address immediate mineralocorticoid needs; fludrocortisone is mainly a mineralocorticoid and not suitable as the initial glucocorticoid replacement in an acute crisis. Therefore, hydrocortisone is the best initial therapy to cover potential adrenal insufficiency in myxedema coma.