management and prognosis

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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.

Primary insufficiency:

  • 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)

Secondary insufficiency:

  • 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.

Prognosis:

  • 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)

Note:

  • 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).

Reference:

Last reviewed 01/2018

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