Primary Adrenal Insufficiency When Hydrocortisone or Cortisone Acetate Has Not Normalized Electrolytes and Blood Pressure

This protocol applies to patients with primary adrenal insufficiency (PAI) who have been treated with standard first-line glucocorticoid and mineralocorticoid replacement but have not reached the expected treatment goals.

First-Line Goals Not Met

Initial therapy with hydrocortisone or cortisone acetate — along with fludrocortisone where aldosterone deficiency was confirmed — did not achieve electrolytes within the normal range and normal blood pressure without evidence of postural hypotension.

Next-Line Approach

In this setting, an alternative oral glucocorticoid — prednisolone — is considered as the next therapeutic step. The complete structured regimen and clinical guidance are contained in the full protocol.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1210/jc.2015-1710

As an alternative to hydrocortisone, we suggest using prednisolone (3-5 mg/d), administered orally once or twice daily, especially in patients with reduced compliance.

When PAI patients fail to recover in terms of HRQoL and working capacity or have difficulty adhering to a multiple-dose regimen, prednisolone, 3-5 mg/d administered in one or two doses, can be prescribed.

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