Which corticosteroid has the highest mineralocorticoid to glucocorticoid potency ratio, making it most appropriate for adrenal insufficiency requiring both cortisol replacement AND mineralocorticoid supplementation?
- A Fludrocortisone ✓
- B Dexamethasone
- C Betamethasone
- D Triamcinolone
Correct answer: A. Fludrocortisone
Explanation
Fludrocortisone is a synthetic fluorinated corticosteroid with approximately 125× the mineralocorticoid potency of cortisol, while retaining moderate glucocorticoid activity. This extreme mineralocorticoid potency makes it the drug of choice for mineralocorticoid replacement in Addison's disease and congenital adrenal hyperplasia. Dexamethasone and betamethasone are fluorinated analogues with essentially zero mineralocorticoid activity but very high glucocorticoid potency (25–30× hydrocortisone). Triamcinolone also has negligible mineralocorticoid activity.
Reference: KD Tripathi, Essentials of Medical Pharmacology, 8th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.