Therapy for adrenal insufficiency

Adrenal insufficiency is a rare disorder in which the adrenal cortex fails to secrete sufficient amounts of steroid hormones. All adrenal hormones are affected in primary adrenal insufficiency, whereas only glucocorticoid secretion is deficient in secondary adrenal insufficiency. Low doses of hydrocortisone/cortisone acetate (20 mg and 25 mg daily, respectively) subdivided in thrice-daily administration approach the physiological cortisol profile and resolve clinical features. Clinical assessment is the mainstay for establishing adequacy of corticosteroid replacement therapy as no biochemical/hormonal marker is fully reliable. Glucocorticoid replacement has to be potentiated during stressful events (e.g., surgery, infection, delivery and trauma). Fludrocortisone (0.05 - 0.2 mg daily) is administered in order to normalise blood pressure and potassium levels, aiming for plasma renin activity in the upper normal range. Dehydroepiandrosterone (20 - 50 mg daily) may prove beneficial, but cannot as yet be recommended for routine clinical use.