management and prognosis
Seek specialist advice.
Treat cause and replace glucocorticoid and mineralocorticoid, supplemented by careful and persistent education. Patients should carry a steroid card and MedicAlert bracelet.
- hydrocortisone - 15-25 mg/day, dosage depends on the bodyweight, metabolism and absorption (2), for example:for example:
- 10 mg in the morning
- 5 mg at midday
- 5 mg in the evening
- fludrocortisone - in a single dose of 50-200 μg/day, dosage depends on metabolism and exercise levels (2)
- measure blood pressure and serum electrolytes to assess adequacy of mineralocorticoid therapy
- complications include hypokalaemia, hypertension, oedema and cardiac enlargement
- adjust doses of both drugs according to postural hypotension, plasma urea and electrolytes
- dehydroepiandrosterone (DHEA) - 25-50 mg/day usually as a single morning dose (2)
- as above but may not require mineralocorticoid
- may require thyroxine if there is hypothalamic-pituitary disease
Note Addison's disease may be associated with other autoimmune disease - screening for thyroid disease (autoimmune thyroid disease is associated with Addison's disease) should be undertaken, especially if there is an inadequate response to treatment.
- requires life long treatment
- with the right balance of daily medication patients can have a normal lifespan and lead full and productive lives (1)
- untreated Addison’s disease is fatal and may lead to death quite rapidly due to adrenal crisis (1)
- the Addison’s Clinical Advisory Panel (ACAP) recommends that all steroid dependant patients should be supplied with a six monthly repeat prescription of their essential steroid medication to avoid risk of running out
- GP’s also should check for possible drug interaction during each time when issuing a new prescription (1).
- (1) Wass, J., Howlett, T., Arlt, W. et al. Diagnosing Addison's: a guide for GPs. Addison's Disease Self Help Group 2009
- (2) Wass, J., Howlett, T., Arlt, W. et al. Caring for the Addison's patient: information for GPs. Addison's Disease Self Help Group 2007
Last reviewed 01/2018