Seek specialist advice. (1,2)
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, 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
- 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
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
- over-treatment with glucocorticoids may result in obesity, diabetes, and osteoporosis (3)
- untreated Addison’s disease is fatal and may lead to death quite rapidly due to adrenal crisis
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.
Reference:
- Husebye ES, Pearce SH, Krone NP, et al. Adrenal insufficiency. Lancet. 2021 Feb 13;397(10274):613-29.
- Bancos I, Hahner S, Tomlinson J, Arlt W. Diagnosis and management of adrenal insufficiency. Lancet Diabetes Endocrinol. 2015 Mar;3(3):216-26
- Chantzichristos D, Eliasson B, Johannsson G. Management of endocrine disease. Disease burden and treatment challenges in patients with both Addison's disease and type 1 diabetes mellitus. Eur J Endocrinol. 2020 Jul;183(1):R1-R11.