From the Guidelines
Addison's disease cannot be surgically corrected in most cases. The primary treatment for Addison's disease is hormone replacement therapy, not surgery, as stated in the consensus statement on the diagnosis, treatment and follow-up of patients with primary adrenal insufficiency 1. Patients typically require daily oral glucocorticoids and mineralocorticoids to replace the hormones that the adrenal glands can no longer produce.
Key Considerations
- Surgery may only be considered in very specific situations, such as when Addison's disease is caused by a tumor that can be removed, but this is rare.
- The vast majority of Addison's disease cases are autoimmune in nature, where the body's immune system has damaged the adrenal glands, or they result from other non-surgical conditions.
- Patients with Addison's disease need to carry emergency medication (injectable hydrocortisone) and wear medical alert identification, as stress situations require increased medication dosages to prevent life-threatening adrenal crisis, as outlined in the treatment guidelines for patients with primary adrenal insufficiency 1.
Treatment During Surgery
According to the guidelines, patients with Addison's disease undergoing major surgery require 100 mg hydrocortisone im just before anesthesia, and continued 100 mg hydrocortisone im every 6 h until able to eat and drink, then double oral dose for 48+ h, then taper to normal dose 1.
Postoperative Care
Postoperative care for patients with Addison's disease is crucial to prevent adrenal crisis, and the guidelines provide specific recommendations for different types of procedures, including major surgery, minor surgery, and dental procedures 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) 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 FDA drug label does not answer the question.
From the Research
Surgical Correction of Addison's Disease
- There is no evidence to suggest that Addison's disease can be surgically corrected 2, 3, 4, 5, 6.
- The current treatment for Addison's disease consists of replacing the deficient hormones, such as glucocorticoids and mineralocorticoids, through medication 3, 4, 5, 6.
- The goal of treatment is to simulate the normal physiological serum cortisol rhythm and to manage the symptoms of the disease 2, 3, 4, 5, 6.
- Some studies have explored new treatment modalities, such as modified-released hydrocortisone and continuous subcutaneous hydrocortisone infusion, to improve patient health and quality of life 2.
- However, surgical correction of Addison's disease is not a viable treatment option, and management of the disease relies on medical therapy and patient education 4, 5, 6.