Dr Gillani"s Blog: Endocrinology : Treatment / Management Of Addison"s Disease :

Endocrinology : Treatment / Management Of Addison"s Disease :

Treatment

Treatment for Addison's disease involves medication.

The patients are given hormone replacement therapy to correct the levels of steroid hormones the body isn't producing.

Some options for treatment include oral corticosteroids such as:

Hydrocortisone (Solucortef), prednisone or methylprednisolone to replace cortisol.

These hormones are given on a schedule to mimic the normal 24-hour fluctuation of cortisol levels.

Fludrocortisone acetate to replace aldosterone.

Plenty of salt (sodium) should be added in the diet, especially during heavy exercise or if patient gets gastroenteritis.

If the body is stressed, such as from an operation, an infection or a minor illness the dose of steroids may have to be increased.

If the patient is vomiting and can't keep down oral medications, they may need injections of corticosteroids.

Other treatment recommendations include:

Carrying a medical alert card and bracelet at all times.

A steroid emergency card and medical alert identification will let emergency medical personnel know what kind of care the patient needs.

Keeping a written action plan.

Keeping extra medication handy.

Carrying a glucocorticoid injection kit might be a good idea.

The kit contains a needle, syringe and injectable form of corticosteroids to use in case of emergency.

Missing even one day of medication may be dangerous, so keeping a small supply of medication at work and whenever the patient travels.

Staying in contact with one”s doctor and keeping them update of their condition.

Management of Addisonian Crisis :

Treatment for an addisonian crisis, which is a medical emergency, typically includes intravenous injections of:

Fluids / Saline solution

The patient in Addisonian crisis is significantly depleted of both salt and water.

Aggressive fluid resuscitation with 0.9 % saline is vital.

Glucocorticoids / Corticosteroids Replacement :

Give hydrocortisone iv 100 – 200 mg immediately and then 100 mg iv three times a day.

Fludrocortisone treatment needs to be considered in the long term.

But in the acute situation , hydrocortisone remains the treatment of choice.

Glucose monitoring :

There is always a risk of hypoglycemia.

Finger prick blood glucose monitoring should be done regularly.

If needed, a 10 % dextrose drip may be started at a rate to keep blood glucose more than 5 mmol/l but should not be given more than needed .

5 % dextrose should be avoided as it may cause / exacerbate Hyponatremia.

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