The adequacy of glucocorticoid replacement (hydorcortisone, prednisone) must be assessed clinically. A WBC (white blood count) with differential (the percentage of lymphocytes and polymorphonuclear (PMN) leukocytes) can help, since patients whose replacement dose is too high tend to have a relative lymphopenia (lower percent lymphocytes), while those on excessive doses tend to have a higher percent PMN leukocytes.
Patients receiving fludrocortisone (Florinef) can be assessed for adequacy of replacement by assessment of blood pressure and serum sodium (Na) and potassium (K). Sometimes these can be normal but patients may be under-replaced and not feeling completely well; assessment of plasma renin activity (PRA) may help, since it tends to be elevated in patients who are not receiving adequate fludrocortisone.
