How are symptoms of Addison's disease managed?

From the Guidelines

Addison's disease symptoms are primarily managed through hormone replacement therapy, including daily oral glucocorticoids such as hydrocortisone (15-20 mg in divided doses) and mineralocorticoid replacement with fludrocortisone (0.05-0.1 mg/d), with adjustments based on individual patient needs and responses. The management approach is tailored to the severity of symptoms, with asymptomatic or mild symptoms (G1) involving initiation of replacement therapy with hydrocortisone and consideration of holding immune checkpoint inhibitor therapy until the patient is stabilized on replacement hormone 1. For moderate symptoms (G2), outpatient corticosteroid treatment at 2-3 times maintenance dose may be initiated, along with fludrocortisone, and for severe symptoms (G3-4), inpatient management with normal saline, IV stress dose steroids, and tapering to oral maintenance doses over 5-7 days is recommended 1.

Key aspects of management include:

• Education on steroid stress dosing, emergency injections, and the use of a medical alert bracelet or necklace
• Titration of hydrocortisone to a maximum of 30 mg daily total dose for residual symptoms of adrenal insufficiency
• Adjustment of fludrocortisone based on volume status, sodium level, and renin response
• Regular monitoring of blood pressure, electrolytes, and plasma renin activity to ensure proper dosing
• Patient education on symptoms of insufficient and excessive steroid replacement to prevent complications

The goal of management is to prevent adrenal crisis, ensure adequate hormone replacement, and maintain quality of life, with early endocrinology consultation being crucial for planning before surgery or high-stress treatments 1. Additionally, guidelines from other sources, such as the Association of Anaesthetists, the Royal College of Physicians, and the Society for Endocrinology UK, provide recommendations for the management of glucocorticoids during the peri-operative period for patients with adrenal insufficiency 1.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION Dosage depends on the severity of the disease and the response of the patient. Patients should be continually monitored for signs that indicate dosage adjustment is necessary, such as remission or exacerbations of the disease and stress (surgery, infection, trauma) Addison's Disease In Addison’s disease, the combination of fludrocortisone acetate tablets with a glucocorticoid such as hydrocortisone or cortisone provides substitution therapy approximating normal adrenal activity with minimal risks of unwanted effects.

The symptoms of Addison's disease are managed with substitution therapy using a combination of fludrocortisone acetate and a glucocorticoid such as hydrocortisone or cortisone. The dosage depends on the severity of the disease and the patient's response, and patients should be continually monitored for signs that indicate dosage adjustment is necessary, such as remission or exacerbations of the disease and stress 2.

• The usual dose of fludrocortisone acetate is 0.1 mg daily.
• The dose of glucocorticoid such as hydrocortisone is 10 mg to 30 mg daily in divided doses.
• The dose of cortisone is 10 mg to 37.5 mg daily in divided doses.

From the Research

Symptoms of Addison's Disease

The symptoms of Addison's disease can be managed through various treatment modalities, including:

• Replacement therapy with glucocorticoids and mineralocorticoids 3, 4, 5, 6, 7
• Oral glucocorticoid and mineralocorticoid replacement therapy, which is the conventional treatment for Addison's disease 3
• Timed-release hydrocortisone tablets and continuous subcutaneous hydrocortisone infusion, which are promising new treatment modalities 3, 4

Treatment Options

The treatment options for Addison's disease include:

• Glucocorticoid replacement therapy, which should be started with a dose of 15-20 mg for hydrocortisone or 20-30 mg for cortisone acetate, divided into two or three doses 3
• Mineralocorticoid replacement therapy, which should be started with a dose of 0.05-0.20 mg of fludrocortisone once daily 3, 5, 6
• Replacement therapy with dehydroepiandrosterone (DHEA), which has shown inconsistent benefits on health-related quality of life (HRQoL) 3, 5, 6

Management of Symptoms

The management of symptoms of Addison's disease requires:

• Close monitoring of the patient's condition and adjustment of the treatment regimen as needed 7
• Patient education on how to manage their condition, including how to double or triple their hydrocortisone dose in case of fever or infection, and how to switch to parenteral hydrocortisone in case of vomiting, diarrhea, or acute hypotension 7
• Regular follow-up with a healthcare provider to monitor the patient's condition and adjust the treatment regimen as needed 3, 4, 5, 6, 7