Secondary adrenal insufficiency medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Amandeep Singh M.D.[2]
Overview
The mainstay of treatment for secondary adrenal insufficiency is treating the underlying cause. For symptomatic cases, hydrocortisone should be administered. The long-term treatment goal is to maintain normal blood pressure, blood glucose, fluid volume, and a sense of well-being in the patient.
Medical therapy
The mainstay of treatment for secondary adrenal insufficiency is identifying and treating the underlying cause and replacement of deficient hormones which is mainly cortisol in this case.[1]
- Adrenal crisis is mainly seen with primary adrenal insufficiency or Addison's disease. However, it can also manifest in secondary or tertiary adrenal insufficiency in the events of acute illnesses.[2]
Acute secondary adrenal insufficiency or adrenal crisis management
The mainstay of treatment includes glucocorticosteroids and supportive therapy.[3][4]
- Maintain airway, breathing, and circulation.
- Normal saline 0.9% or 5% dextrose in normal saline should be administered to correct hypotension and dehydration.
- Supplementation of adequate glucocorticoids.
- Careful monitoring of blood pressure, fluid status, and serum sodium and potassium levels should be maintained.
- Hypotension seen in secondary adrenal insufficiency is due to loss of vasomotor tone and not mainly due volume loss.
Longterm management
The long-term treatment goal is to maintain normal blood pressure, blood glucose, fluid volume, and a sense of well-being in the patient.[5]
- Adequate daily supplementation of glucocorticoid to mimic normal physiology.
- Supplementation of ACTH and other pituitary hormones in case of hypopituitarism. The replacement of thyroid hormone without replacing glucocorticoid can cause adrenal insufficiency.
- Advise patients on medication for minor illness (febrile illness or emesis) to double or triple their usual dose of glucocorticoid. In case of severe illness, they should inject themselves with a large dose of glucocorticoid and seek immediate medical attention.[6][7]
References
- ↑ Gan EH, Pearce SH (2017). "MANAGEMENT OF ENDOCRINE DISEASE: Regenerative therapies in autoimmune Addison's disease". Eur. J. Endocrinol. 176 (3): R123–R135. doi:10.1530/EJE-16-0581. PMID 27810905.
- ↑ Inder WJ, Meyer C, Hunt PJ (2015). "Management of hypertension and heart failure in patients with Addison's disease". Clin. Endocrinol. (Oxf). 82 (6): 789–92. doi:10.1111/cen.12592. PMID 25138826.
- ↑ Tucci V, Sokari T (2014). "The clinical manifestations, diagnosis, and treatment of adrenal emergencies". Emerg. Med. Clin. North Am. 32 (2): 465–84. doi:10.1016/j.emc.2014.01.006. PMID 24766944.
- ↑ Napier C, Pearce SH (2014). "Current and emerging therapies for Addison's disease". Curr Opin Endocrinol Diabetes Obes. 21 (3): 147–53. doi:10.1097/MED.0000000000000067. PMID 24755997.
- ↑ Grossman A, Johannsson G, Quinkler M, Zelissen P (2013). "Therapy of endocrine disease: Perspectives on the management of adrenal insufficiency: clinical insights from across Europe". Eur. J. Endocrinol. 169 (6): R165–75. doi:10.1530/EJE-13-0450. PMC 3805018. PMID 24031090.
- ↑ Napier C, Pearce SH (2012). "Autoimmune Addison's disease". Presse Med. 41 (12 P 2): e626–35. doi:10.1016/j.lpm.2012.09.010. PMID 23177474.
- ↑ Quinkler M (2012). "[Addison's disease]". Med Klin Intensivmed Notfmed (in German). 107 (6): 454–9. doi:10.1007/s00063-012-0112-3. PMID 22907517.