The Treatment of Hypoadrenalism
Author: mzPOTTER
What can your doctor do?
The GP may prescribe blood tests to determine levels of electrolytes (sodium and potassium), renal function, and baseline levels of cortisol. Hydrocortisone treatment may, if the diagnosis is obvious, instituted immediately after blood collection. It is necessary to refer the patient to the endocrinologist.
What can you do?
Treatment is usually for life. The neglect or abandonment of it can be fatal for the patient, so you should take some precautions. The biggest problem is that the needs of cortisol increases during physical stress such as major surgical interventions. We strongly recommend that all patients always carry a card warning of his condition and explaining that dependent patients are treated with cortisol. This can save lives in case of collapse or coma. Patients with Addison’s disease should take extra supplies of medication home, take them also when they go on vacation, and to always have a vial of hydrocortisone in case. Any health professional can, if the patient is unconscious or unable to swallow at the time of oral medication, administer this medication.
What can a specialist?
The best replacement therapy for this disease is hydrocortisone, a hormone similar to cortisol and easily measured in blood. The correct levels of this hormone can be checked by removing a sample of blood just before the first dose of hydrocortisone, and at regular intervals after each dose of the same, this is called “curve of hydrocortisone daily.” Samples should be drawn up at night. The purpose is to maintain high cortisol levels (but not more than 1000nm/l) in the morning and lowest in the afternoon and evening (between 100 and 300nmol/l). The usual dose is 10 mg taken in the morning, 5 mg in making food and other 5 mg in the evening.
You can use other steroids, including cortisone acetate, prednisolone and dexamethasone. However, it is more difficult to determine the correct dose of prednisolone or dexamethasone, which may lead (the dose too high) to complications such as avascular hip necrosis, osteoporosis, worsening of diabetes or hypertension.
Most patients usually have other deficits of adrenal hormones such as aldosterone. This requires replacement therapy with the synthetic form of aldosterone, called fluorhidrocortisona. The usual dose is taken in the morning upon waking, of 1mcg in one pill.
The hormone produced in the adrenal medulla is epinephrine (a catecholamine) and do not usually necessary to establish replacement therapy because this hormone can be produced in other parts of the sympathetic nervous system, adrenal medulla which is one of its components.
If the patient has a process with fever, diarrhea or vomiting, you should double the dose of hydrocortisone for 48 or 72 hours. We need an intramuscular injection of hydrocortisone (or intravenous) in cases of serious illness or major surgery. This treatment compensates for stress.
Untreated blood pressure drops too low and there is a collapse, which can be fatal. Catecholamines, drugs used to increase blood pressure are ineffective in cases of absence of cortisol. All such patients should be seen by a specialist in endocrinology at least once a year, and should have access to specialist advice 24 hours a day.
What is the expected outcome?
With treatment and follow-up, both life expectancy and quality of it can be quite normal.