hormonal and metabolic disorders
Adrenal Insufficiency
Treatment of Adrenal Insufficiency
Corticosteroids Regardless of the cause, adrenal insufficiency can be life threatening and must be treated with corticosteroids and intravenous fluids. Usually, treatment can be started withhydrocortisone(the drug form ofcortisol) orprednisone(a synthetic corticosteroid) taken by mouth. However, people who are severely ill may be givenhydrocortisoneintravenously or intramuscularly at first and thenhydrocortisonetablets. Because the body normally produces mostcortisolin the morning, replacementhydrocortisoneshould also be taken in divided doses, with the largest dose in the morning.Hydrocortisonewill need to be taken every day for the rest of the person’s life. Larger doses ofhydrocortisoneare needed when the body is stressed, especially as a result of an illness, and may need to be given by injection if the person has severe diarrhea or vomiting. Most people with primary adrenal insufficiency also need to takefludrocortisonetablets every day to help restore the body’s normal excretion of sodium and potassium. Supplementaltestosteroneis not usually needed, although there is some evidence that replacement with DHEA improves the quality of life in some people. Although treatment must be continued for life, the outlook is excellent. People with adrenal insufficiency should carry a card or wear a bracelet or necklace that identifies them as having the disorder and that lists their drugs and doses in case they become ill and cannot communicate that information. They should also carry an injection ofhydrocortisonefor use in an emergency. 