Paediatrics: Adrenal insufficiency: treatment

Adrenal insufficiency: treatment

Primary adrenal insufficiency requires both glucocorticoid and mineralo-corticoid replacement therapy. 1^o adrenal insufficiency requires glucocor-ticoid therapy only.

·  Glucocorticoid therapy:

·  hydrocortisone—oral 12–15mg/m²/day in 2–3 divided doses per day. Usually about two-thirds of the dose is given in the morning, in an attempt to mimic normal diurnal variation in cortisol secretion.

·  During times of illness and stress (e.g. infection, trauma, surgery) patients are advised to increase their normal daily maintenance dose of hydrocortisone by 2 to 3 times.

·  Mineralocorticoid therapy: fludrocortisone—oral 50–150micrograms/ day. Monitor BP and plasma renin levels.

Adrenal crises

An adrenal (or Addisonian) crisis is an acute exacerbation of an underlying adrenal insufficiency brought on by ‘stresses’ that necessitate increased production and secretion of cortisol from the adrenal gland. This is a life-threatening emergency and should be treated if there is a strong clinical suspicion rather than waiting for confirmatory test results. Typical causes include infection, trauma, and surgery. Symptoms include:

·  nausea/vomiting;

·  abdominal pain;

·  lethargy/somnolence;

·  hypotension.

Treatment

·  Immediate IV bolus of hydrocortisone followed by 6-hourly repeat injections.

IVI fluids/glucose.