Addison's Disease Treatment: Glucocorticoid and Mineralocorticoid Replacement

Addison's disease (primary adrenal insufficiency) requires lifelong hormone replacement to replicate physiological cortisol and aldosterone rhythms.

Glucocorticoid Replacement

• Hydrocortisone (cortisol): 15–25 mg/day divided: ½–⅔ AM, ⅓–½ early PM (mimics diurnal rhythm).
• Alternatives: Prednisolone 3–5 mg/day (longer half-life), cortisone acetate 20–35 mg/day.
• Stress Dosing: Double/triple for fever >38°C, surgery, trauma, vomiting. IV hydrocortisone 100 mg bolus then 200 mg/24h infusion for adrenal crisis.

Mineralocorticoid Replacement

• Fludrocortisone: 0.05–0.2 mg/day. Adjust for BP, electrolytes, renin, edema.
• No separate aldosterone replacement available.

Monitoring

• Clinical: weight, BP (orthostatics), energy, salt craving.
• Labs: Na⁺, K⁺, glucose, renin, ACTH (diagnostic only), 17-OHP (if 21-hydroxylase deficiency).
• DEXA scan for bone health (chronic glucocorticoid effect).

Patient Essentials

• Medical alert bracelet/necklace.
• Emergency injection kit (hydrocortisone 100 mg IM) + training.
• Sick-day rules written plan.
• Pregnancy: dose adjustments; continue fludrocortisone.