Adrenal insufficiency medical therapy

Jump to navigation Jump to search

Adrenal insufficiency Microchapters


Patient Information


Historical Perspective




Differentiating Xyz from other Diseases

Epidemiology and Demographics

Risk Factors


Natural History, Complications and Prognosis


Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings



Echocardiography and Ultrasound

CT scan


Other Imaging Findings

Other Diagnostic Studies


Medical Therapy



Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Adrenal insufficiency medical therapy On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides


American Roentgen Ray Society Images of Adrenal insufficiency medical therapy

All Images
Echo & Ultrasound
CT Images

Ongoing Trials at Clinical

US National Guidelines Clearinghouse

NICE Guidance

FDA on Adrenal insufficiency medical therapy

CDC on Adrenal insufficiency medical therapy

Adrenal insufficiency medical therapy in the news

Blogs on Adrenal insufficiency medical therapy

Directions to Hospitals Treating Psoriasis

Risk calculators and risk factors for Adrenal insufficiency medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ayeesha Kattubadi, M.B.B.S[2]


Pharmacologic medical therapy is recommended among patients with adrenal insufficiency Pharmacologic medical therapies for adrenal insufficiency include lifelong glucocorticoid and mineralocorticoid replacement therapy. Mineralocorticoid replacement therapy is only used in patients with primary adrenal insufficiency.

Medical Therapy

Adrenal insufficiency

  • Glucocorticoid replacement therapy
    • 1.1 Adult
      • Preferred regimen (1): Hydrocortisone 15-25mg PO, 2/3 of the total dose in the morning on awakening; 1/3 of the total dose in mid-afternoon lifelong
      • Preferred regimen (2): Hydrocortisone 15-25mg PO, three divided doses (10mg at 7 AM, 5mg at 12 PM, and 2.5-5mg at 4:30 PM. Avoid dosing after 6 PM) lifelong
      • Alternative regimen (1): Cortisone acetate 20-25mg PO, once in the morning, lifelong.
      • Alternative regimen (2): Prednisone 3-5mg/day PO, once in the morning lifelong.

Specific instructions:
Drug interactions:
Drugs increasing glucocorticoid dose requirement: Anticonvulsants like Barbiturates, Topiramate, Anti-tubercular drugs, Estrogens, Tamoxifen
Drugs decreasing glucocorticoid dose requirement: Licorice, Grapefruit juice, Colestipol
Monitoring is done based on clinical improvement.
Symptoms that are suggestive of under-dosing: Persistence or the incomplete resolution of fatigue, nausea, postural hypotension, myalgia.
Symptoms that are suggestive of overdosing: weight gain, edema, abdominal striae.
There is no role of measuring ACTH and serum cortisol levels.
Side effects of glucocorticoid replacement therapy:
Weight gain, edema, increased appetite, weight gain, osteoporosis, dyslipidemia, increased cardiovascular risk.

  • Glucocorticoid replacement therapy
    • 1.2 Pediatric
      • Preferred regimen: Hydrocortisone 7-10 mg/m2/day PO in three or four divided doses.

Specific instructions:
Avoid using prednisolone, hydrocortisone in children
Monitoring: Clinical improvement, tracking growth velocity, body weight, blood pressure, energy levels.

  • Mineralocorticoid replacement therapy

Specific instructions:
Based on the clinical picture Symptoms and signs that are suggestive of under-dosing: hypovolemia, orthostatic hypotension, hyperkalemia, hyperuricemia, increased plasma renin activity.
Symptoms and signs of overdosing: hypertension, hypokalemia, edema. If a patient on fludrocortisone develops hypertension first step is to reduce the dose. If the blood pressure remains elevated, start an antihypertensive medication, and continue fludrocortisone.

  • Mineralocorticoid replacement therapy

Specific instructions:
In newborns and children, higher dose upto 0.5mg of fludrocortisone maybe required because of lower mineralocorticoid sensitivity. [4]

  • Dehydroepiandrosterone (DHEA):

Its use is not routinely recommended.
A six-month trial of DHEA can be considered in patients with significant impairment in quality of life, decreased libido, women, depressed mood despite glucocorticoid and mineralocorticoid therapy. If there is no improvement at the end of six months, its use has to be discontinued. Contraindications: People with breast and prostate cancer.


  1. Bornstein, Stefan R.; Allolio, Bruno; Arlt, Wiebke; Barthel, Andreas; Don-Wauchope, Andrew; Hammer, Gary D.; Husebye, Eystein S.; Merke, Deborah P.; Murad, M. Hassan; Stratakis, Constantine A.; Torpy, David J. (2016). "Diagnosis and Treatment of Primary Adrenal Insufficiency: An Endocrine Society Clinical Practice Guideline". The Journal of Clinical Endocrinology & Metabolism. 101 (2): 364–389. doi:10.1210/jc.2015-1710. ISSN 0021-972X.
  2. Oprea, Alina; Bonnet, Nicolas C. G.; Pollé, Olivier; Lysy, Philippe A. (2019). "Novel insights into glucocorticoid replacement therapy for pediatric and adult adrenal insufficiency". Therapeutic Advances in Endocrinology and Metabolism. 10: 204201881882129. doi:10.1177/2042018818821294. ISSN 2042-0188.
  4. Esposito, Daniela; Pasquali, Daniela; Johannsson, Gudmundur (2018). "Primary Adrenal Insufficiency: Managing Mineralocorticoid Replacement Therapy". The Journal of Clinical Endocrinology & Metabolism. 103 (2): 376–387. doi:10.1210/jc.2017-01928. ISSN 0021-972X.

Template:WH Template:WS