fludrocortisone / Generic mfg. - LARVOL DELTA

Adrenal insufficiency in sickle cell disease: A Case series of a potentially underrecognized complication (ASH 2025) - "Therefore, fludrocortisone was initiated in this patient in addition to glucocorticoids...Severe disease requiring regular red cell exchanges, chronic opioid use, and iron overload, may represent potential risk factors for the development of AI, suggesting that patients with these complications may benefit from targeted or regular screening. These cases underscore the need for further investigation into the prevalence, risk factors, and approach to the evaluation of AI in SCD to better inform screening and diagnostic guidelines."

Clinical • Cardiovascular • Endocrine Disorders • Genetic Disorders • Hematological Disorders • Nephrology • Renal Disease • Sickle Cell Disease • Venous Thromboembolism

A rare presentation of cardiomyopathy associated with Addison's disease: a case report. (PubMed, Eur Heart J Case Rep) - "A short synacthen test confirmed the diagnosis, and he was started on dual therapy with hydrocortisone and fludrocortisone. It serves as a reminder of the complex physiological interactions that can cause cardiomyopathy, and further research is vital to improve understanding. Timely recognition and prompt treatment with steroids can lead to rapid reversal of cardiac function."

Journal • Cardiomyopathy • Cardiovascular • Congestive Heart Failure • Endocrine Disorders • Heart Failure • Nephrology • Rare Diseases • Renal Disease

Diagnostic pitfalls in aldosterone defects: a 9-year follow-up of early-onset pseudohypoaldosteronism type 2. (PubMed, J Pediatr Endocrinol Metab) - "Aldosterone pathway defects may be misdiagnosed during the initial clinical assessment. This underscores the importance of a comprehensive diagnostic approach incorporating biochemical profiling and genetic testing to ensure accurate identification. Next-generation sequencing has emerged as a valuable tool for establishing a definitive diagnosis, particularly in cases with aldosterone defects. Timely and accurate diagnosis of PHA2 is critical, as persistent metabolic acidosis and hypertension may lead to significant growth and developmental impairments in pediatric patients. Despite the potential severity of clinical manifestations associated with CUL3-related PHA2, it is noteworthy that treatment with thiazide diuretics alone can effectively restore electrolyte balance and support normal growth and development."

Journal • Cardiovascular • Heart Failure • Hypertension • Metabolic Disorders • Pediatrics • WNK1

Microvillus Inclusion Disease: Successful Treatment of Severe Hyponatremia With High-Dose Fludrocortisone via a Possible Gut-Mediated Mechanism. (PubMed, ACG Case Rep J) - "High-dose fludrocortisone (100 mcg bid; 28.4 mcg/kg/d) successfully restored serum sodium levels and reduced stool output, with normalization of renin and aldosterone, without adverse effects. This case demonstrates a potential therapeutic benefit of gastrointestinal mineralocorticoid receptor agonism in managing severe hyponatremia in patients with MVID during periods of acute decompensation."

Journal • Cardiovascular • Heart Failure

Progress in the pharmacological management of vasovagal syncope. (PubMed, Expert Rev Clin Pharmacol) - "Atomoxetine is under investigation. Some benefit from fludrocortisone, midodrine, or serotonin-specific reuptake inhibitors. Almost all patients eventually stop fainting, and invasive treatments should be used last and for the very few highly afflicted patients who do not improve with safer measures."

Journal • Review • Hypotension • Psychiatry

Delayed Diagnosis of X-Linked Adrenal Hypoplasia Congenita in a Boy with a Novel NR0B1 Variant: A Case Report. (PubMed, Children (Basel)) - "The patient received hydrocortisone (10-12 mg/m2/day) and fludrocortisone (0.1 mg/day) as replacement therapy for adrenal insufficiency, along with testosterone supplementation (100-240 mg/day) to induce pubertal progression. Early recognition and genetic confirmation are critical for appropriate management and genetic counseling. Identification of novel variants expands the NR0B1 mutational spectrum and enhances our understanding of genotype-phenotype correlations in X-linked AHC."

Journal • Endocrine Disorders • Nephrology • Renal Disease • NR0B1

OMAHA-004: A Study of Opevesostat (MK-5684) Versus Alternative Next-generation Hormonal Agent (NHA) in Metastatic Castration-resistant Prostate Cancer (mCRPC) Post One NHA (MK-5684-004) (clinicaltrials.gov) - P3 | N=1314 | Recruiting | Sponsor: Merck Sharp & Dohme LLC | Active, not recruiting ➔ Recruiting

Enrollment open • Castration-Resistant Prostate Cancer • Genito-urinary Cancer • Oncology • Prostate Cancer • Solid Tumor

Single-Center Experience in Five Patients Diagnosed with Lipoid Congenital Adrenal Hyperplasia Due to Steroidogenic Acute Regulatory Protein (STAR) Gene Variants: A Rare Cause of Adrenal Insufficiency. (PubMed, J Clin Res Pediatr Endocrinol) - "All received hydrocortisone and fludrocortisone. LCAH is a rare genetic disorder that can present with life-threatening adrenal insufficiency. However, as demonstrated in our cases, early diagnosis and appropriate treatment can lead to excellent outcomes."

Journal • Cardiovascular • Congenital Adrenal Hyperplasia • Endocrine Disorders • Genetic Disorders • Heart Failure • Nephrology • Pediatrics • Renal Disease • STAR

Control, Fludrocortisone or Midodrine for the treatment of Orthostatic Hypotension: CONFORM-OH pilot RCT and economic evaluation. (PubMed, Health Technol Assess) - "To answer the research question, novel trial designs are needed. This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number NIHR127385."

HEOR • Journal • Cardiovascular • Hypotension • Infectious Disease • Movement Disorders • Novel Coronavirus Disease

An Antifungal Tradeoff: A Case of Adrenal Insufficiency from Long-Term Fluconazole Treatment of Coccidiomycosis (KIDNEY WEEK 2025) - "While posaconazole and itraconazole can cause adrenal steroidogenesis leading to pseudohyperaldosteronism, ketoconazole is most frequently reported azole to cause primary adrenal insufficiency by inhibiting 11b-hydroxylase and 17a hydroxylase enzymes responsible for the production of cortisol...He received insulin, dextrose, calcium gluconate, albuterol inhaler, and sodium zirconium cyclosilicate for his hyperkalemia...After clinical diagnosis of primary adrenal insufficiency, hydrocortisone 10 mg BID and fludrocortisone 0.1 mg was inititated daily...Chronic exposure to high doses of fluconazole could potentially impair cortisol synthesis through inhibition of steroidogenic enzymes leading to primary adrenal insuffiency. We believe it is important to bring awareness of this underrecognized risk to prevent delayed diagnosis and management."

Clinical • Cardiovascular • Dermatology • Endocrine Disorders • Hypertension • Metabolic Disorders • Nephrology • Renal Disease • Respiratory Diseases

Bortezomib Induced Peripheral and Severe Autonomic Neuropathy Characterized By Dizziness, Orthostatic Hypotension and Weight Loss (ASH 2023) - "B was given in combination with lenalidomide and dexamethasone (VRD) but we feel the neuropathic symptoms are more due to B since the combination of just lenalidomide and dexamethasone is not known to cause such complications...13 of 16 received VRD and 3 received Daratumumab, B and dexamethasone-based induction...Nine patients received appetite stimulants; 2 megestrol and 7 dronabinol...11 of the 16 patients had dizziness; 3 patients received fludrocortisone and one received midodrine...Transplantation without resolution of symptoms could possibly worsen the morbidity and delay post-transplant recovery. To the best of our knowledge, we are the first group to report a series of patients with this symptom complex and strongly feel it requires further study in a larger cohort."

Anorexia • Diabetes • Diabetic Neuropathy • Gastrointestinal Disorder • Hematological Malignancies • Hypotension • Metabolic Disorders • Mucositis • Multiple Myeloma • Nephrology • Neuralgia • Oncology • Orthopedics • Pain • Peripheral Neuropathic Pain • Renal Disease

Substudy 01A: Safety and Efficacy of Opevesostat (MK-5684)-Based Treatment Combinations or Opevesostat Alone in Participants With Metastatic Castration-resistant Prostate Cancer (mCRPC) (MK-5684-01A) (clinicaltrials.gov) - P1/2 | N=220 | Recruiting | Sponsor: Merck Sharp & Dohme LLC | Trial completion date: Mar 2028 ➔ Jan 2029 | Trial primary completion date: Mar 2028 ➔ Jan 2029

Trial completion date • Trial primary completion date • Castration-Resistant Prostate Cancer • Genito-urinary Cancer • Oncology • Prostate Cancer • Solid Tumor

Type 4 Renal Tubular Acidosis (RTA) Due to Nonsteroidal Anti-Inflammatory Drug (NSAID) Use (KIDNEY WEEK 2025) - "Kidney biopsy confirmed light-chain nephropathy due to multiple myeloma and chemotherapy was initiated with rapid improvement of renal function (creatinine 3.6 meq/l),but persistent hyperkalemia at 5.5 meq/L,bicarbonate 17 meq/L,anion gap 10.Urine K 16 meq/L,Na 64 meq/L,Cl 39 meq/L,urine creatinine 77.1 mg/dl for a urine anion gap of 41, and spot urine K/creatinine of 21 meq/g.With fludrocortisone serum potassium rapidly improved to 4.8 meq/L,and bicarbonate improved to 19 meq/L Discussion Hypoaldosteronism causes hyperkalemic metabolic acidosis.Hyperkalemia impairs ammoniagenesis in the proximal tubule and reduces urinary ammonia to buffer urinary hydrogen ions and elimination of hydrogen ions.Use of NSAIDs are known to induce hypoaldosteronism and type 4 RTA.Multiple myeloma is also associated with RTA but classically a proximal RTA type 2 In our case, despite rapid improvement in renal function, hyperkalemia and non-anion gap metabolic acidosis persisted, with a..."

Acute Kidney Injury • Back Pain • Cardiovascular • Heart Failure • Hematological Malignancies • Metabolic Disorders • Multiple Myeloma • Musculoskeletal Diseases • Musculoskeletal Pain • Nephrology • Orthopedics • Renal Disease

Adrenal Insufficiency Due to Adrenal Hemorrhage in a Neonate in the Context of In Utero Buprenorphine Exposure (KIDNEY WEEK 2025) - "Hydrocortisone, fludrocortisone, and sodium chloride supplementation were started. Figure 1: Trending biochemical abnormalities. Figure 2: Ultrasound images of the adrenal and kidneys at DOL#8 and DOL#88"

Cardiovascular • Endocrine Disorders • Heart Failure • Hematological Disorders • Hepatology • Infectious Disease • Metabolic Disorders • Nephrology • Obstetrics • Renal Disease • Septic Shock • Substance Abuse

When Nephrology and Endocrine Axes Meet: Hyponatremia and Hyperkalemia Due to Late-Onset Autoimmune Polyglandular Syndrome Type 2 (KIDNEY WEEK 2025) - "She was subsequently started on fludrocortisone with resolution of symptoms and electrolyte abnormalities ( Figure )...Altered sodium and potassium handling and impaired H+ secretion were consequences of mineralocorticoid deficiency due to unrecognized AI. This case illustrates how AI alters distal tubular function, leading to hyponatremia, hyperkalemia, and metabolic acidosis."

Cardiovascular • Diabetes • Endocrine Disorders • Heart Failure • Immunology • Metabolic Disorders • Nephrology • Osteoporosis • Renal Disease • Rheumatology • Type 1 Diabetes Mellitus • Type 2 Diabetes Mellitus

Cerebral Salt-Wasting Syndrome Masquerading as Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) in a Patient with Subdural Hemorrhage (KIDNEY WEEK 2025) - "His home medications included insulin, losartan, mirtazapine, and doxazosin...To prevent worsening hyponatremia with ongoing natriuresis, he was started on sodium tablets, urea tablets, and fludrocortisone...The common etiologies of CSWS include central nervous system pathologies, the most common being aneurysmal subarachnoid hemorrhage. This case underscores the importance of monitoring volume status and electrolytes in neurologically injured patients with hyponatremia."

Clinical • Benign Prostatic Hyperplasia • Cachexia • Cardiovascular • CNS Disorders • Diabetes • Heart Failure • Hematological Disorders • Hypertension • Metabolic Disorders • Musculoskeletal Diseases • Nephrology • Orthopedics • Subarachnoid Hemorrhage

AKI with Hyponatremia from Rivaroxaban-Induced Bilateral Adrenal Hemorrhage (KIDNEY WEEK 2025) - "Morning cortisol was low at 3.0 ug/dL and remained 3.0 ug/dL at 30 and 60 minutes post-cosyntropin administration. Endocrinology was consulted and started stress dose IV hydrocortisone (HC) with taper to oral (20mg/10mg every morning/evening) and fludrocortisone 0.05 mg daily...He was monitored in the outpatient setting and successfully converted to apixaban after a period of clinical stability...Although rare, adrenal hemorrhage has been described with the newer direct oral anticoagulants. Early detection can facilitate timely treatment and earlier engagement of appropriate consultants to improve outcomes."

Acute Kidney Injury • Anorexia • Cardiovascular • Endocrine Disorders • Fatigue • Heart Failure • Hematological Disorders • Hypotension • Immunology • Nephrology • Pulmonary Embolism • Renal Disease • Thrombosis

A Case of Severe Postobstructive Diuresis Requiring Prolonged Inpatient Treatment (KIDNEY WEEK 2025) - "During the 4 th week, fludrocortisone and midodrine were discontinued upon improvement of the polyuria and resolution of the orthostasis. On follow up, a component of free water diuresis was evident, and desmopressin was added with significant decrease in urine output and simultaneous increase in urine osmolarity. This unusual and severe course may be predicted by the chronicity of the obstruction and resulting severity of the kidney insult."

Clinical • Cardiovascular • Hypertension • Hypotension • Metabolic Disorders • Nephrology

Recurrent severe hypercalcemia in a nasopharyngeal carcinoma survivor. (PubMed, Intern Emerg Med) - "Discontinuation of calcium/vitamin D supplementation and initiation of low-dose prednisolone and fludrocortisone led to resolution of hypercalcemia and renal impairment. This case highlights the importance of recognizing dual non-malignant etiologies in cancer survivors with suppressed PTH/PTHrP and persistent hypercalcemia, particularly when urinary calcium excretion remains high despite renal impairment."

Journal • Chronic Kidney Disease • Endocrine Disorders • Hypotension • Metabolic Disorders • Nasopharyngeal Carcinoma • Nephrology • Oncology • Renal Disease • Solid Tumor • COL1A2 • PTHLH

Long-term kidney function stabilization with fludrocortisone in autosomal recessive renal tubular dysgenesis: a case report. (PubMed, Pediatr Nephrol) - "We report a 10-year-old girl with autosomal recessive renal tubular dysgenesis (ARRTD), a genetic form of RTD caused by mutations in RAS-related genes. She initially experienced recurrent dehydration, electrolyte abnormalities, and kidney dysfunction due to polyuria but showed long-term improvement following fludrocortisone therapy."

Journal • Hypotension • Nephrology • Rare Diseases • Renal Disease

A Study to Evaluate the Effect of MK-5684 in Male Participants With Severe Renal Impairment (RI) and With End-stage Renal Disease (ESRD) (MK-5684-010) (clinicaltrials.gov) - P1 | N=24 | Completed | Sponsor: Merck Sharp & Dohme LLC | Active, not recruiting ➔ Completed

Trial completion • Chronic Kidney Disease • Nephrology • Renal Disease

Joint Hypermobility: An Under-Recognised Cause of Palpitations, Dizziness, and Syncope in Young Females. (PubMed, J Clin Med) - "Conservative measures (hydration, salt intake, and exercise) were effective in over half of the cases; pharmacological treatments (ivabradine, fludrocortisone) were considered for refractory cases. They are multi-system conditions affecting both physical and mental health, which remain under-recognised and are often dismissed as 'functional', particularly in women-highlighting gender bias in diagnosis. A structured diagnostic approach with routine joint assessments for JH and increased awareness can facilitate early recognition and management in general medical settings, reducing reliance on emergency services and improving patient outcomes."

Journal • Cardiovascular • Fatigue • Genetic Disorders • Hypotension • Mood Disorders • Musculoskeletal Diseases • Musculoskeletal Pain • Orthopedics • Pain • Psychiatry

UNVEILING ADRENAL HISTOPLASMOSIS: A RARE CAUSE OF ADRENAL INSUFFICIENCY IN AN IMMUNOCOMPETENT HOST (CHEST 2025) - "Suspicion of PAI was confirmed with low serum cortisol, elevated serum ACTH (>600 pg/ mL; reference: 10-60 pg/mL), and absent cortisol response (5.7 to 6.2 mcg/dL) on ACTH stimulation test, alluded to possible Addison's disease.The patient was started on hydrocortisone and fludrocortisone, leading to improvement in his symptoms and stabilization of sodium levels...Given his cardiac history, treatment with isavuconazole was initiated due to its safer cardiovascular profile... The presence of bilateral adrenal thickening and granulomatous inflammation should raise suspicion for infections like histoplasmosis, even in immunocompetent hosts. Prolonged environmental exposure to H. capsulatum spores, such as in this patient's case, likely facilitated the insidious dissemination. This case highlights the need for a broad differential diagnosis in patients with adrenal masses, especially when adrenal insufficiency is present."

Cardiovascular • Coronary Artery Disease • Dyslipidemia • Endocrine Disorders • Fatigue • Gastroesophageal Reflux Disease • Human Immunodeficiency Virus • Hypotension • Infectious Disease • Inflammation • Nephrology • Rare Diseases • Renal Disease • Rheumatology

Exercise-Induced Colon Ischemia in a Middle-Aged Female Athlete: Response to a Novel Therapeutic Approach of Sildenafil and Fludrocortisone. (PubMed, ACG Case Rep J) - "Initial workup was unrevealing, prompting a clinical diagnosis of exercise-induced colon ischemia from transient, reversible mesenteric vasoconstriction. Treatment with the vasodilator sildenafil and fludrocortisone for blood pressure support resulted in symptom resolution and her ability to return to exercise without adverse gastrointestinal symptoms."

Journal • Cardiovascular • Pain

Fludrocortisone for Refractory Hypotension in a Hospitalized Dialysis Patient: A Case Report. (PubMed, Cureus) - "We present the case of a 74-year-old woman with stage 4 chronic kidney disease (CKD) who developed acute kidney injury (AKI) due to drug-induced acute interstitial nephritis (AIN) following exposure to piperacillin-tazobactam 2.25 grams three times a day and ursodiol 600 mg daily...The patient was commenced on stress-dose hydrocortisone and midodrine, but hypotension persisted...Fludrocortisone, commonly used in ambulatory dialysis, proved valuable in this case by demonstrating efficacy in the acute inpatient setting, initiated at a dose of 0.1 mg and titrated to 0.2 mg daily. It underscores the therapeutic role of fludrocortisone in managing refractory hypotension due to adrenal insufficiency, even in patients with minimal residual renal function, and emphasizes the importance of early recognition and treatment of corticosteroid-induced adrenal suppression in CKD patients."

Journal • Acute Kidney Injury • Cardiovascular • Chronic Kidney Disease • Congestive Heart Failure • Endocrine Disorders • Heart Failure • Hypotension • Nephrology • Renal Disease