Which laboratory values should be monitored in a patient with adrenal hypofunction receiving steroid replacement?

Which laboratory values should be monitored in a patient with adrenal hypofunction receiving steroid replacement?

• A. Monitor BUN levels
• B. Monitor platelets
• C. Monitor liver enzymes
• D. Monitor calcium

Answer: (A)

Glucocorticoid replacement for adrenal hypofunction drives a catabolic metabolism, especially on proteins. That increased protein breakdown leads to more urea production, so BUN becomes a practical gauge of how the replacement is affecting the body's metabolic state and how well the kidneys are clearing those waste products. Monitoring BUN helps detect whether the dose is causing excessive catabolism or if dehydration or impaired renal perfusion is occurring, guiding dose adjustments and hydration management. Platelets, liver enzymes, and calcium are not primary indicators of how well steroid replacement is functioning in this context; they may be relevant in other scenarios (such as long-term bone health for calcium) but they don’t reflect the immediate metabolic response to glucocorticoids the way BUN does.

Glucocorticoid replacement for adrenal hypofunction drives a catabolic metabolism, especially on proteins. That increased protein breakdown leads to more urea production, so BUN becomes a practical gauge of how the replacement is affecting the body's metabolic state and how well the kidneys are clearing those waste products. Monitoring BUN helps detect whether the dose is causing excessive catabolism or if dehydration or impaired renal perfusion is occurring, guiding dose adjustments and hydration management.

Platelets, liver enzymes, and calcium are not primary indicators of how well steroid replacement is functioning in this context; they may be relevant in other scenarios (such as long-term bone health for calcium) but they don’t reflect the immediate metabolic response to glucocorticoids the way BUN does.