Therapy
The therapy of primary adrenal insufficiency consists of the replacement of the missing substances. Glucocorticoid deficiency must be substituted by oral administration of 20 – 30 mg of cortisone per day. The natural fluctuation of the cortisone level is observed: 20 mg in the morning, 10 mg in the evening.
This is supplemented by taking dexamethasone in the evening, the dosage of which is adjusted to activities and special situations (e.g. operations, infections). The mineral corticosteroids can also be replaced by medication and the dose can be adjusted to the various stresses. The patient should be given an Addison’s passport and should always carry it with them. Detailed information and training of the patient and relatives is recommended in order to be able to react competently in stressful situations.
Prognosis of Addison’s disease
Primary adrenal insufficiency is fatal if untreated. The hormone substitution must take place for life. If drugs are taken regularly and the dosage is adjusted to the different situations, the affected persons can expect a normal life expectancy.
If there is a suspicion of Addison’s disease due to the existing symptoms, blood is first taken and analyzed. In primary adrenal cortex insufficiency, the following blood parameters are altered: It is essential to know whether a primary, secondary or even tertiary form of adrenal insufficiency is present. In order to clarify this, on the one hand the symptoms are indicative.
The diagnosis of Addison’s disease must nevertheless be confirmed by further tests. The so-called ACTH stimulation test is used to clarify the suspicion of adrenal cortical insufficiency. If the cortisol value is above 200μg/l after 60 minutes, adrenal cortex insufficiency is ruled out.
If the cortisol level is below a certain value (less than 200μg/l) after 60 minutes after stimulation, the patient is suffering from insufficiency. After that, the concentration of ACTH is decisive. Normal or elevated values indicate a primary form, lower values indicate a secondary or tertiary form.The CRH test is used to differentiate between the secondary and tertiary forms of Addison’s disease. If there is no or only a small increase in cortisol and ACTH, the secondary form is present, whereas the tertiary form is present when ACTH increases and there is no or only a small increase in cortisol.
- Sodium lowered
- Potassium increased
- ACTH increased
- Cortisol humiliated
- Antibody detection
