| Adrenal insufficiency is a life threatening
chronic illness. An active and vigorous lifestyle with normal life
expectancy is possible as long as the prescribed medications are taken
regularly and adjusted when indicated. As with most chronic diseases,
adrenal insufficiency demands that the patients take responsibility
and develop self-management skills and techniques. The following guidelines
and general advice should help you in this endeavor.
You should obtain and always wear a medical alert bracelet or tag
and carry an emergency identification card. These items should identify
your underlying diagnosis of the fact that you have adrenal insufficiency.
The name and telephone number for both your primary physician and
endocrinologist should be listed on the emergency medical identification
Adrenal insufficiency is treated with glucocorticoids and mineralocorticoids.
Pituitary patients do not require mineralocorticoids. Glucocorticoid
and mineralocorticoid hormones are typically given in doses that
approximate the normal daily production of these hormones. Three
glucocorticoid hormones are commonly used in the treatment of patients
with adrenal insufficiency. These include Hydrocortisone, Prednisone,
and Dexamethasone. Your doctor will select one of these hormones
and a dosing schedule that should provide for your glucocorticoid
hormone needs. Dexamethasone is usually administered once daily,
often at bedtime. Prednisone may be administered either at bedtime
or upon arising. A second dose may be required in the late afternoon.
Hydrocortisone is typically administered upon arising. A second
dose may be recommended in the late afternoon. Alternatively, Hydrocortisone
can be administered upon arising, at lunch, and at the time of the
evening meal. You should work with your physician to determine the
most appropriate glucocorticoid and scheduled to suit your needs.
Florinef is usually taken once a day, but some patients require
twice daily or even every other day dosing schedules. Patients taking
Florinef are often advised to maintain a liberal salt intake in
order to prevent dehydration. Florinef dose requirements may change
with the seasons.
In people with normal functioning of the pituitary and adrenal
glands, minor febrile illnesses and stresses provoke increased adrenal
output of hydrocortisone. Patients with adrenal insufficiency cannot
muster this response. You must, therefore, consciously be aware
of the need for increased doses of Hydrocortisone and adjust their
doses when indicated. Glucocorticoid doses should be doubled or
tripled for a few days for fevers greater than 100.5° Fahrenheit,
flu-like illnesses, or minor injuries. If the illness worsens or
persists for more than three to four days, you should contact your
physician or endocrinologist for further advice. Usually, you will
be asked to report to the office for a history and physical examination
to permit an assessment of glucocorticoid needs.
Significant injuries and illnesses should prompt either a tripling
of the dose of Hydrocortisone and a doubling of the dose of Florinef,
or immediate injection of Dexamethasone intramuscularly. Inability
to tolerate your medication by mouth should prompt injection of
Dexamethasone intramuscularly. Obviously, in these circumstances
you should be seen and evaluated by a physician immediately. This
might require that you visit your local emergency room for immediate
attention. Flu-like illnesses associated with nausea and vomiting
may require hospitalization to permit the intravenous administration
of glucocorticoid hormones.
Management of steroids during hospitalization and at the time of
medical procedures is usually directed by a physician. It is quite
important that your physician be knowledgeable regarding the specifics
of and indications for steroid therapy. Prompt and frequent communication
between your physician and endocrinologist is of utmost importance.
You, the patient, should make certain that your physician is aware
that adjustments in glucocorticoid doses are required for moderately
stressful procedures such as barium enemas, endoscopy, arteriography,
and certain surgical procedures. Many patients refuse to undergo
said procedures unless they can be certain that their physician
has made arrangements to administer the appropriate dose of Hydrocortisone
just before the procedure. Extra supplementation is generally not
required for outpatient dental procedures performed under local
anesthesia, minor surgical procedures under local anesthesia, and
noninvasive radiological studies. If you have a question as to whether
or not additional steroids are required, contact your physician
or endocrinologist for further advice.
A Quick Reference For The Most Common Symptoms Of Adrenal Hormone Replacement
by Paul Margulies, M.D.
Most common symptoms of glucocorticoid (cortisol) deficiency
: nausea, loss of appetite, Severe fatigue, weakness, weight loss, hyperpigmentation.
Most common symptoms of
glucocorticoid (cortisol) excess: Weight gain, fatigue, easy bruising, muscle weakness, redness in the face, pink stretch marks, mood swings.
Most common symptoms of mineralocorticoid [fludrocortisone acetate (Florinef)] deficiency: Reduced blood pressure, dizziness on standing, salt craving, muscle cramps.
Most common symptoms of mineralocorticoid [fludrocortisone acetate (Florinef)] excess: Hypertension, ankle swelling, exertion headache.
NADF does not engage in the practice of medicine. It is not a medical authority, nor does it claim to have medical
knowledge. In all cases, NADF recommends that you consult your own physician regarding any course of treatment or