Adrenal atrophy medical therapy: Difference between revisions
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*[[Intravenous fluids]] | *[[Intravenous fluids]] | ||
*Intravenous [[steroids ]] | *Intravenous [[steroids ]] | ||
The cortisol deficiency is treated by supplementing with [[cortisol]], [[prednisolone]], [[prednisone]], [[methylprednisolone]], and [[dexamethasone]]. | *Detection of underlying cause | ||
The [[ | |||
In [[adrenal crisis]], [[intravenous]] fluids in addition to intravenous [[steroids]] are prescribed. It is currently suggested to use 100 mg IV bolus of [[hydrocortisone]], followed by 50 mg IV every 6 hours (or 200 mg/24 hours as a continuous IV infusion for the first 24 hours) in patients presented with adrenal crisis. However, [[mineralocorticoid]] replacement is not necessary acutely because it takes several days for its sodium-retaining effects to appear, and adequate [[sodium]] replacement can be achieved by IV [[saline]] alone. After the initial bolus, hydrocortisone 50 mg IV bolus is administered every six hours until stabilization of [[vital signs]] and capacity to eat and take medication orally. | |||
The detection of the underlying condition, which has yielded to [[adrenal crisis]], including severe systemic [[illness]], [[infection]], [[fasting]], or [[surgery]], should be detected and managed, appropriately. | |||
In the long-term management of patients with adrenal atrophy, the [[cortisol]] deficiency is treated by supplementing with [[cortisol]], [[prednisolone]], [[prednisone]], [[methylprednisolone]], and [[dexamethasone]]. The ideal [[glucocorticoid]] replacement therapy should mimic the endogenous cortisol rhythm, with a nadir at bedtime and peak values in the early morning before waking. Use of short-acting [[glucocorticoid]], [[hydrocortisone]], in two or three divided doses is though suggested to mimic the natural [[biorhythm]]. It is currently suggested to supply a total daily hydrocortisone dose of 10 to 12 mg/m2. | |||
The mineralocorticoid insufficiency is also cured by the [[fludrocortisone]], which is given orally in a usual dose of 0.1 mg/day. A lower dose (such as 0.05 mg/day) may be sufficient in patients receiving [[hydrocortisone]], which has some [[mineralocorticoid]] activity. The mineralocorticoid dose may have to be increased in the summer, when salt loss in perspiration increases. However, the adequacy of mineralocorticoid replacement should be monitored by asking about symptoms of postural [[hypotension]] and measuring supine and upright [[blood pressure]] and pulse, serum [[potassium]], and plasma [[renin]] activity. | |||
. <ref name="pmid19500761">{{cite journal |vauthors=Hahner S, Allolio B |title=Therapeutic management of adrenal insufficiency |journal=Best Pract Res Clin Endocrinol Metab |volume=23 |issue=2 |pages=167–79 |date=April 2009 |pmid=19500761 |doi=10.1016/j.beem.2008.09.009 |url=}}</ref><ref name="pmid7170268">{{cite journal |vauthors=Barnett AH, Espiner EA, Donald RA |title=Patients presenting with Addison's disease need not be pigmented |journal=Postgrad Med J |volume=58 |issue=685 |pages=690–2 |date=November 1982 |pmid=7170268 |pmc=2426562 |doi=10.1136/pgmj.58.685.690 |url=}}</ref> | |||
==References== | ==References== | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Maryam Hadipour, M.D.[2]
Overview
Treatment of adrenal atrophy is conservative. In case of adrenal crisis IV fluid and steroid are recommended.
Medical therapy
Adrenal atrophy is the irreversible damage to the adrenal tissue, due to direct trauma or the secondary causes. As a result, treatment of the adrenal atrophy is a conservative treatment. For adrenal crisis:
- Intravenous fluids
- Intravenous steroids
- Detection of underlying cause
In adrenal crisis, intravenous fluids in addition to intravenous steroids are prescribed. It is currently suggested to use 100 mg IV bolus of hydrocortisone, followed by 50 mg IV every 6 hours (or 200 mg/24 hours as a continuous IV infusion for the first 24 hours) in patients presented with adrenal crisis. However, mineralocorticoid replacement is not necessary acutely because it takes several days for its sodium-retaining effects to appear, and adequate sodium replacement can be achieved by IV saline alone. After the initial bolus, hydrocortisone 50 mg IV bolus is administered every six hours until stabilization of vital signs and capacity to eat and take medication orally.
The detection of the underlying condition, which has yielded to adrenal crisis, including severe systemic illness, infection, fasting, or surgery, should be detected and managed, appropriately.
In the long-term management of patients with adrenal atrophy, the cortisol deficiency is treated by supplementing with cortisol, prednisolone, prednisone, methylprednisolone, and dexamethasone. The ideal glucocorticoid replacement therapy should mimic the endogenous cortisol rhythm, with a nadir at bedtime and peak values in the early morning before waking. Use of short-acting glucocorticoid, hydrocortisone, in two or three divided doses is though suggested to mimic the natural biorhythm. It is currently suggested to supply a total daily hydrocortisone dose of 10 to 12 mg/m2. The mineralocorticoid insufficiency is also cured by the fludrocortisone, which is given orally in a usual dose of 0.1 mg/day. A lower dose (such as 0.05 mg/day) may be sufficient in patients receiving hydrocortisone, which has some mineralocorticoid activity. The mineralocorticoid dose may have to be increased in the summer, when salt loss in perspiration increases. However, the adequacy of mineralocorticoid replacement should be monitored by asking about symptoms of postural hypotension and measuring supine and upright blood pressure and pulse, serum potassium, and plasma renin activity. . [1][2]
References
- ↑ Hahner S, Allolio B (April 2009). "Therapeutic management of adrenal insufficiency". Best Pract Res Clin Endocrinol Metab. 23 (2): 167–79. doi:10.1016/j.beem.2008.09.009. PMID 19500761.
- ↑ Barnett AH, Espiner EA, Donald RA (November 1982). "Patients presenting with Addison's disease need not be pigmented". Postgrad Med J. 58 (685): 690–2. doi:10.1136/pgmj.58.685.690. PMC 2426562. PMID 7170268.