Treatment of Primary Adrenal Insufficiency in Adrenal Crisis or Severe Adrenal Insufficiency Symptoms
When primary adrenal insufficiency presents acutely — as an adrenal crisis or with severe adrenal insufficiency symptoms — the situation is a clinical emergency that demands immediate intervention, without waiting for diagnostic results to return.
Clinical Scenario
This protocol addresses patients with primary adrenal insufficiency who present with adrenal crisis or severe adrenal insufficiency symptoms. Timely recognition is critical: treatment should begin immediately, prior to confirmation from laboratory testing.
Treatment Approach — Partial Overview
Initial management centres on an immediate parenteral glucocorticoid injection combined with rapid fluid resuscitation. The protocol covers agent selection — including alternatives when the preferred glucocorticoid is not available — as well as dose adjustment, tapering, and the subsequent transition to an oral regimen guided by the patient's clinical state.
Complete agent selection criteria, dosing, tapering schedule, and transition algorithm are in the full protocol…
References
DOI: 10.1210/jc.2015-1710
- In patients with severe adrenal insufficiency symptoms or adrenal crisis, we recommend immediate therapy with iv hydrocortisone at an appropriate stress dose prior to the availability of the results of diagnostic tests.
- We recommend that patients with suspected adrenal crisis should be treated with an immediate parenteral injection of 100 mg (50 mg/m2 for children) hydrocortisone, followed by appropriate fluid resuscitation and 200 mg (50–100 mg/m2 for children) of hydrocortisone/24 hours (via continuous iv therapy or 6 hourly injection); age- and body surface-appropriate dosing is required in children (see Table 3).
- If hydrocortisone is unavailable, we suggest prednisolone as an alternative. Dexamethasone is the least-preferred alternative and should only be given if no other glucocorticoid is available.
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