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How to Treat Adrenal Insufficiency?


Things to note:
  • All patients should wear a notification bracelet.

Medical Treatment:
Acute crisis
Exclude sepsis.
  • Hydrocortisone, IV, 200 mg 6 hourly.
Change to oral maintenance therapy once stable.
To maintain adequate intravascular volume guided by blood pressure:
  • Sodium chloride 0.9%, IV.
The fluid deficit is often several litres.
Monitor glucose levels closely and treat hypoglycaemia if present.
Chronic
As maintenance therapy:
  • Hydrocortisone, oral.
    • Start with 10 mg in the morning and 5 mg at night.
    • Increase the dose according to clinical response up to 20 mg in the morning and 10 mg at night.
OR
  • Prednisone, oral.
    • Start with 5 mg daily.
    • Increase to maximum of 7.5 mg daily, if necessary.
For patients who remain symptomatically hypotensive:
  • Fludrocortisone, oral, 50-100 mcg daily.
Monitor response to therapy with:
  • Symptoms: Improvement in fatigue and GIT disturbances.
  • Blood pressure: Normotensive and no postural drop.
  • Electrolytes: Normal Na+ and K+.
During times of severe stress i.e. acute illness, surgery, trauma, etc:
  • Hydrocortisone, IV, 100 mg 6 hourly.
With minor stress maintenance therapy should be doubled for the duration of illness and gradually tapered to usual dose.

When to refer:
  • All suspected cases for full evaluation.