MRCP2-1662

MRCP2-1662

A 42-year-old man comes to the endocrinology clinic for follow-up. He was diagnosed with Addison’s disease six months ago after experiencing symptoms of malaise, postural dizziness, and vomiting. He was started on hydrocortisone and has since reported improvement in his symptoms. His hydrocortisone dose was increased from 10mg in the morning and 5mg at lunchtime and 5mg in the early afternoon to 10mg, 10mg, and 5mg for the morning, lunchtime, and afternoon, respectively. However, he now presents with ankle swelling. On examination, he has non-pitting edema of his legs, a heart rate of 78 bpm, blood pressure of 165/102 mmHg, saturations of 98% on room air, and a respiratory rate of 14 breaths per minute. His previous blood pressure recorded in clinic had been 105/61 mmHg. He has no other medical problems and takes only paracetamol and ibuprofen as needed for headaches. What is the most appropriate course of action?