What Is the Treatment for Primary Adrenal Insufficiency?
Primary adrenal insufficiency requires hormonal replacement therapy. This page summarises the first-line treatment framework and the clinical targets that define adequate control.
Treatment Approach
Management is built on glucocorticoid replacement, administered orally on a timed schedule. For patients with confirmed aldosterone deficiency, mineralocorticoid replacement is added. The full protocol specifies the agents, dosing structure, and decision criteria.
Treatment Goals
The targets for adequate replacement are electrolytes within the normal range and normal blood pressure without evidence of postural hypotension.
References
DOI: 10.1210/jc.2015-1710
We recommend glucocorticoid therapy in all patients with confirmed PAI.
We suggest using hydrocortisone (15-25 mg) or cortisone acetate (20-35 mg) in two or three divided oral doses per day; the highest dose should be given in the morning at awakening, the next either in the early afternoon (2 h after lunch; two-dose regimen) or at lunch and afternoon (three-dose regimen).
We recommend that all patients with confirmed aldosterone deficiency receive mineralocorticoid replacement with fludrocortisone (starting dose, 50-100 µg in adults) and not restrict their salt intake.
General well-being, electrolytes within the normal range, and normal blood pressure without evidence of postural hypotension indicate adequate mineralocorticoid replacement.
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