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For all patients with primary or secondary adrenal hypofunction, corticosteroid replacement, usually with cortisone or hydrocortisone (both of which also have a mineralocorticoid effect), is the primary treatment and must continue throughout life. Adrenal hypofunction may also necessitate treatment with I.V. desoxycorticosterone, a pure mineralocorticoid, or oral fludrocortisone, a synthetic mineralocorticoid; both prevent dangerous dehydration and hypotension.
Adrenal crisis requires prompt I.V. bolus administration of hydrocortisone. Later, doses are given I.M. or are diluted with dextrose in saline solution and given I.V. until the patient’s condition stabilizes.
With proper treatment, adrenal crisis usually subsides quickly; the patient’s blood pressure should stabilize, and water and sodium levels should return to normal. After the crisis, maintenance doses of hydrocortisone preserve physiologic stability.
Source: Professional Guide to Diseases (Eighth Edition), 2005
For all patients with primary or secondary adrenal hypofunction, lifelong corticosteroid replacement, usually with cortisone or hydrocortisone (both of which also have a mineralocorticoid effect) is the primary treatment.
For patients with Addison’s disease, treatment with oral fludrocortisone, a synthetic mineralocorticoid, is necessary to prevent dangerous dehydration, hypotension, and electrolyte disturbances with hyponatremia and hyperkalemia. (See Avoiding adrenal crisis.)
For those with adrenal crisis, prompt I.V. bolus administration of 100 mg of hydrocortisone is key. Later, 50- to 100-mg doses are given I.M. or are diluted with dextrose in saline solution and given I.V. until the patient’s condition stabilizes; up to 300 mg/day of hydrocortisone and 3 to 5 L of I.V. saline solution are required during the acute stage of adrenal crisis.
With proper treatment, adrenal crisis usually subsides quickly; the patient’s blood pressure stabilizes, and water and sodium levels return to normal. After the crisis, maintenance doses of hydrocortisone preserve physiologic stability.
Source: Handbook of Diseases, 2003
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