TREATMENT
The treatment of adrenal insufficiency consists of replacing the missing hormones.45 The treatment of an adrenal crisis theoretically would require administration of ˜200 mg of hydrocortisone
daily. The standard regimen used in most centers provides 400 mg per day intravenously, approximately twice the amount calculated to be necessary. The basal production rate of cortisol has been thought to be 12 to 15 mg/m2 per day. Some studies have challenged this, however, suggesting that the production rate of cortisol may be lower by as much as half. Nevertheless, replacement of cortisol at the rate of 12 to 15 mg/m2 per day provides an adequate amount of bioactive cortisol at the cellular level. Although current practice favors a split dose of cortisol, the frequency of administration often can be reduced to once a day. In the author’s experience, compliance is enhanced by a once-a-day regimen.
daily. The standard regimen used in most centers provides 400 mg per day intravenously, approximately twice the amount calculated to be necessary. The basal production rate of cortisol has been thought to be 12 to 15 mg/m2 per day. Some studies have challenged this, however, suggesting that the production rate of cortisol may be lower by as much as half. Nevertheless, replacement of cortisol at the rate of 12 to 15 mg/m2 per day provides an adequate amount of bioactive cortisol at the cellular level. Although current practice favors a split dose of cortisol, the frequency of administration often can be reduced to once a day. In the author’s experience, compliance is enhanced by a once-a-day regimen.
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