management of hypoadrenalism

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Management is directed towards rapid elevation of circulating glucocorticoid and replacement of salt and glucose loss.

By the General Practitioner:

  • hydrocortisone 100 mg im - effects last 6 hrs - or 100 mg iv - effects last 4 hrs, blood sample, immediate transfer to hospital

In hospital:

  • hydrocortisone 100 mg im or iv
  • 1 litre normal saline infused over 30-60 mins with 5% dextrose if hypoglycaemic; several litres may needed subsequently
  • continue hydrocortisone 6 hourly until the patient is stable - at this dose, no fludrocortisone is required because high cortisol exerts weak mineralocorticoid action
  • oral replacement may begin after 24 hours and be reduced to maintenance over 3-4 days
  • fludrocortisone may be introduced later

Last reviewed 01/2018