NBME form 2 - cortisol - shine10

[ArchivalUser]

7. A 10-year-old boy with asthma has been receiving oral hydrocortisone daily in increasing doses for the past 2 years. He is obese and has growth retardation and edema of his lower limbs. Which of the following is the most likely explanation for the edema?

A) The drug binds to both glucocorticoid and mineralocorticoid receptors
B) The drug is converted to a mineralocorticoid in the liver
C) Pulmonary production of angiotensin is increased
D) Renin activity is increased because of stress
E) Secretion of ADH (vasopressin) is increased because of stress

[ArchivalUser]

a
?

[ArchivalUser]

what is the right answer pleasew.
thank y

[ArchivalUser]

most likely A) because glucocorticoids have weak mineralocorticoid activity also. Since there is an increased use of glucocorticoids, this can result in edema via it's action on mineralocorticoids

[ArchivalUser]

agree.
Glucocorticoids also contribute to the mineralocorticoid pool as they bind to the mineralocorticoid receptor (MR). With regard to mineralocorticoid potency, 20mg hydrocortisone are equivalent to 0.05 mg fludrocortisone.