What are the treatment options for Addison's disease?

From the Guidelines

Treatment for Addison's disease primarily involves hormone replacement therapy to compensate for the adrenal insufficiency, with the standard treatment including daily oral glucocorticoids such as hydrocortisone (15-25 mg daily, divided into 2-3 doses) or prednisone (5-7.5 mg daily), and mineralocorticoid replacement with fludrocortisone (0.05-0.2 mg once daily) 1. The goal of treatment is to replace the deficient hormones and maintain sodium and potassium balance.

• Daily oral glucocorticoids such as hydrocortisone or prednisone replace cortisol, with dosages adjusted during times of physical stress like illness, surgery, or injury, often requiring 2-3 times the normal dose temporarily 1.
• Mineralocorticoid replacement with fludrocortisone is necessary to maintain sodium and potassium balance, with some patients needing additional salt in their diet, especially during hot weather or intense exercise when more sodium is lost through sweat 1.
• Patients should carry an emergency kit containing injectable hydrocortisone (100 mg) for crisis situations and wear a medical alert bracelet, with regular monitoring of electrolytes, blood pressure, and symptoms helping to ensure optimal treatment 1. The most recent guidelines from 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, emphasizing the importance of stress dosing and emergency preparedness 1. Key considerations in treatment include:
• Adjusting dosages during times of physical stress
• Monitoring electrolytes, blood pressure, and symptoms
• Providing emergency kits and medical alert bracelets
• Educating patients on self-management and recognition of adrenal crisis symptoms. Overall, the treatment of Addison's disease requires a comprehensive approach that addresses the hormonal deficiencies, prevents adrenal crisis, and promotes optimal quality of life, with the most recent guidelines and expert consensus statements guiding clinical practice 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 or cortisone acetate, with starting doses of 15-20 mg for hydrocortisone or 20-30 mg for cortisone acetate, divided into two or three doses 3, 4
• Mineralocorticoid replacement therapy, typically with fludrocortisone 0.05-0.20 mg once daily 3, 4
• Replacement therapy with dehydroepiandrosterone (DHEA) or testosterone, which may be beneficial for selected groups of patients with Addison's disease, although the evidence for benefit is weak 3, 4
• New treatment modalities, such as timed-release hydrocortisone tablets and continuous subcutaneous hydrocortisone infusion, which offer the potential for closer simulation of the physiological serum cortisol rhythm 3, 5

Adjusting Treatment Regimens

Adjusting treatment regimens based on individual patient needs is crucial to minimize over- and under-replacement of glucocorticoids. This can be achieved through:

• Salivary cortisol day curves (SCDC) to assess glucocorticoid replacement therapy and adjust the dose and regimen accordingly 6
• Individualized cortisol exposure and management of patients during infections and other stress-related events 7

Emerging Therapies

Emerging therapies for Addison's disease include:

• Modified-released hydrocortisone and continuous subcutaneous hydrocortisone infusion, which offer the potential for improved patient health and better quality of life 5
• Adrenocorticotropic hormone (ACTH) stimulation and immunomodulatory therapies, which may help modify the natural history of adrenal failure 5