From the Guidelines
The primary treatment for Addison's disease involves hormone replacement therapy to compensate for the adrenal insufficiency, with glucocorticoid replacement typically using hydrocortisone (15-25 mg daily divided into 2-3 doses) and mineralocorticoid replacement using fludrocortisone (0.05-0.2 mg once daily) 1.
Treatment Overview
The treatment for Addison's disease is focused on replacing the deficient hormones to restore normal bodily functions. This includes:
- Glucocorticoid replacement: Hydrocortisone is the preferred choice, with dosages ranging from 15-25 mg daily, divided into 2-3 doses 1.
- Mineralocorticoid replacement: Fludrocortisone is typically used, with a dosage of 0.05-0.2 mg once daily, to maintain sodium and potassium balance 1.
Dose Adjustments
Dosages must be adjusted based on individual response and may need to be increased during times of illness, surgery, or significant stress. The general guideline for stress dosing is to double or triple the glucocorticoid dose 1. For example:
- During major surgery, 100 mg of hydrocortisone may be administered intramuscularly before anesthesia, followed by 100 mg every 6 hours until the patient can eat and drink again 1.
- During minor surgery or dental procedures, an extra dose of hydrocortisone (e.g., 20 mg) may be given before the procedure, and the oral dose may be doubled for 24 hours after the procedure 1.
Monitoring and Emergency Preparedness
Regular monitoring of blood pressure, electrolytes, and symptoms is essential to ensure optimal dosing. Patients should also carry a medical alert card or bracelet and have an emergency injection kit containing hydrocortisone for crisis situations 1.
Quality of Life
With proper medication adherence and dose adjustments, most patients with Addison's disease can lead normal, healthy lives. It is essential to educate patients on the importance of adherence to their medication regimen and to recognize the signs of adrenal crisis, which can be life-threatening if not treated promptly 1.
From the FDA Drug Label
DOSAGE & 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) (see WARNINGSand PRECAUTIONS, General) 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. INDICATIONS & USAGE Fludrocortisone acetate tablets, 0.1 mg are indicated as partial replacement therapy for primary and secondary adrenocortical insufficiency in Addison’s disease and for the treatment of salt-losing adrenogenital syndrome.
The treatment options for Addison's disease include:
- Substitution therapy with fludrocortisone acetate tablets in combination with a glucocorticoid such as hydrocortisone or cortisone, as indicated in 2 and 2.
- Partial replacement therapy with fludrocortisone acetate tablets, as indicated in 2.
- The usual dose of fludrocortisone acetate tablets is 0.1 mg daily, although dosage ranging from 0.1 mg three times a week to 0.2 mg daily has been employed, as indicated in 2.
From the Research
Treatment Options for Addison's Disease
The treatment options for Addison's disease include:
- Glucocorticoid replacement therapy, typically with oral hydrocortisone, with starting doses of 15-20 mg per day, divided into two or three doses 3, 4, 5
- Mineralocorticoid replacement therapy, typically with fludrocortisone, with doses ranging from 0.05-0.20 mg per day 3, 6, 5
- Replacement of adrenal androgens, such as dehydroepiandrosterone (DHEA), although the evidence for its benefit is weak 3, 5
- New treatment modalities, such as timed-release hydrocortisone tablets and continuous subcutaneous hydrocortisone infusion, which may offer closer simulation of the physiological serum cortisol rhythm 3, 7
Management and Surveillance of Therapy
The management and surveillance of therapy for Addison's disease requires experience and attention to several aspects, including:
- Repeated teaching of the patient and relatives about the disease and its treatment 6
- Issuing of an emergency steroid card and prescription of a glucocorticoid emergency set 6
- Prevention of side effects due to overtreatment or undertreatment 6
- Management of acute adrenal failure (adrenal crisis), which requires immediate glucocorticoid administration and fluid substitution 6
Emerging Therapies
Emerging therapies for Addison's disease include:
- Modified-released hydrocortisone and continuous subcutaneous hydrocortisone infusion, which may offer improved simulation of the physiological serum cortisol rhythm 7
- Adrenocorticotropic hormone (ACTH) stimulation and immunomodulatory therapies, which may help modify the natural history of adrenal failure 7