Therapeutic target
Compensation of hormone deficiency
Therapy recommendations
- Therapy with glucocorticoids/mineralocorticoids: 20-30 mg hydrocortisone (mimicking circadian rhythm about 50-60% of the dose in the morning: for example, according to the scheme 10-5-5 or 15-5-0 mg); 0.1 mg fludrocortisone;
- In an emergency, an i.m. injection/suppository of, for example, 100 mg hydrocortisone is administered
- Addisonian crisis: intensive care treatment; 200-300 mg/d hydrocortisone i. v. and fluid substitution (0.9% saline and glucose solutions)
- Patients with Addison’s disease receive an emergency card and must be educated and informed that there is an increased need for glucocortocoid in stressful situations.
- See also under “Further therapy”
Examples of adjustments to the substitution dose of hydrocortisone.
- Fever > 38 °C and < 39 °C: doubling the daily hydrocortisone dose for the period of discomfort; duration of therapy: until clinical improvement is achieved (1-2 days are usually sufficient); duration of therapy: until clinical improvement is achieved.
- Fever > 39 °C: tripling for the period of discomfort.
- Minor surgical procedures (eg, dentist / tooth extraction): additional dose in the morning 1 h before the procedure, then dose doubling for the next 24 h.
- Major surgery under intubation anesthesia, intensive care, trauma, delivery:
- Start: 100 mg hydrocortisone in bolus i. v.; then 200 mg/24 h continuous i. v. or 50 mg hydrocortisone every 6 h i. v. (or i. m.) until oral food intake is possible again
- Duration of therapy: as long as the symptoms persist
- Adrenal crisis: immediate bolus of 100 mg hydrocortisone, then 200 mg hydrocortisone/24 h as a continuous infusion or frequent i. v. or i. m. boluses (50 mg) every 6 h; duration of therapy: as long as symptoms persist
- For further information, see “Further therapy” below.
