Therapies for adrenal insufficiency.
Adrenal insufficiency is a life-threatening disorder. In the treatment of adrenal insufficiency, it is essential to administer the optimal medication at the optimal dose. Glucocorticoids are the main therapeutic approach in all forms of adrenal insufficiency. The recommended protocol for maintenance therapy is 15-25 mg of hydrocortisone, divided into two or three separate doses. Patients with primary adrenal insufficiency generally receive mineralocorticoid replacement comprised of fludrocortisone 0.05-0.2 mg/day. Recently, dehydroepiandrosterone has been proposed as a new therapeutic approach, despite the lack of strong evidence for beneficial effects. Additional glucocorticoid supplementation should be administered in stressful states. During critical illness, inadequate or no temporary increase in the dose of the replacement glucocorticoid can lead to acute adrenal failure. When acute adrenal failure occurs, it becomes necessary to administer intravenous hydrocortisone.
Oki
Kenji
K
Hiroshima University, Department of Molecular and Internal Medicine, Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima-City, Hiroshima 734-8551, Japan. kenji-oki@hiroshima-u.ac.jp
Yamane
Kiminori
K
D000309:Adrenal Insufficiency / Q000188:drug therapy*; D003687:Dehydroepiandrosterone / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D005438:Fludrocortisone / Q000008:administration & dosage / Q000627:therapeutic use*; D020249:Hormone Replacement Therapy; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome
D003687:Dehydroepiandrosterone; D005438:Fludrocortisone; D006854:Hydrocortisone