title: Mineralocorticoid substitution and monitoring in primary adrenal insufficiency.
abstract: Patients with primary adrenal insufficiency usually show pronounced impairment of aldosterone secretion and, therefore, require also mineralocorticoid replacement for full recovery. Clinical signs of mineralocorticoid deficiency comprise hypotension, weakness, salt craving and electrolyte disturbances (hyperkalemia, hyponatremia). Mineralocorticoid deficiency is confirmed by demonstration of profoundly decreased aldosterone and highly elevated plasma renin activity (PRA). Standard replacement consists of 9α-fluorocortisol (fludrocortisone) given once daily as a single oral dose (0.05-0.2 mg). Monitoring of mineralocorticoid replacement consists of clinical assessment (well-being, physical examination, blood pressure, electrolyte measurements) and measurement of PRA aiming at a PRA level in the upper normal range. Current replacement regimens may often be associated with mild hypovolemia. Dose adjustments are frequently needed in pregnancy to compensate for the anti-mineralocorticoid activity of progesterone and in high ambient temperature to avoid sodium depletion. In arterial hypertension a dose reduction is usually recommended, but monitoring for hyperkalemia is required.
authors.affiliation: Endocrinology in Charlottenburg, Berlin, Germany; Charité University Medicine, Berlin, Germany. Electronic address: marcusquinkler@t-online.de.
authors.forename: Marcus
authors.initials: M
authors.lastname: Quinkler
authors.affiliation: Endokrinologikum, Berlin, Germany.
authors.forename: Wolgang
authors.initials: W
authors.lastname: Oelkers
authors.affiliation: Charité University Medicine, Berlin, Germany.
authors.forename: Hanna
authors.initials: H
authors.lastname: Remde
authors.affiliation: Endocrinology and Diabetes Unit, Department of Internal Medicine I, University Hospital of Wuerzburg, Germany. Electronic address: allolio_b@medizin.uni-wuerzburg.de.
authors.forename: Bruno
authors.initials: B
authors.lastname: Allolio
mesh_terms: D000224:Addison Disease / Q000097:blood / Q000188:drug therapy*; D000450:Aldosterone / Q000097:blood*; D001794:Blood Pressure; D005438:Fludrocortisone / Q000627:therapeutic use*; D020249:Hormone Replacement Therapy; D006801:Humans; D011788:Quality of Life; D012083:Renin / Q000097:blood
chemical_list: D000450:Aldosterone; D012083:Renin; D005438:Fludrocortisone
keywords: 9α-fluorocortisol; fludrocortisone; hyperkalemia; hypotension; plasma renin activity; salt craving