Hormone Deficiencies – Adrenal Deficiency

Adrenal insufficiency is a life threatening chronic illness. An active and vigorous lifestyle with normal life expectancy is possible as long as the prescribed medications are taken regularly and adjusted when indicated. As with most chronic diseases, adrenal insufficiency demands that the patients take responsibility and develop self-management skills and techniques. The following guidelines and general advice should help you in this endeavor.

You should obtain and always wear a medical alert bracelet or tag and carry an emergency identification card. These items should identify your underlying diagnosis of the fact that you have adrenal insufficiency. The name and telephone number for both your primary physician and endocrinologist should be listed on the emergency medical identification card.

Adrenal insufficiency is treated with glucocorticoids and mineralocorticoids. Pituitary patients do not require mineralocorticoids. Glucocorticoid and mineralocorticoid hormones are typically given in doses that approximate the normal daily production of these hormones. Three glucocorticoid hormones are commonly used in the treatment of patients with adrenal insufficiency. These include Hydrocortisone, Prednisone, and Dexamethasone. Your doctor will select one of these hormones and a dosing schedule that should provide for your glucocorticoid hormone needs. Dexamethasone is usually administered once daily, often at bedtime. Prednisone may be administered either at bedtime or upon arising. A second dose may be required in the late afternoon. Hydrocortisone is typically administered upon arising. A second dose may be recommended in the late afternoon. Alternatively, Hydrocortisone can be administered upon arising, at lunch, and at the time of the evening meal. You should work with your physician to determine the most appropriate glucocorticoid and scheduled to suit your needs. Florinef is usually taken once a day, but some patients require twice daily or even every other day dosing schedules. Patients taking Florinef are often advised to maintain a liberal salt intake in order to prevent dehydration. Florinef dose requirements may change with the seasons.

In people with normal functioning of the pituitary and adrenal glands, minor febrile illnesses and stresses provoke increased adrenal output of hydrocortisone. Patients with adrenal insufficiency cannot muster this response. You must, therefore, consciously be aware of the need for increased doses of Hydrocortisone and adjust their doses when indicated. Glucocorticoid doses should be doubled or tripled for a few days for fevers greater than 100.5° Fahrenheit, flu-like illnesses, or minor injuries. If the illness worsens or persists for more than three to four days, you should contact your physician or endocrinologist for further advice. Usually, you will be asked to report to the office for a history and physical examination to permit an assessment of glucocorticoid needs.

Significant injuries and illnesses should prompt either a tripling of the dose of Hydrocortisone and a doubling of the dose of Florinef, or immediate injection of Dexamethasone intramuscularly. Inability to tolerate your medication by mouth should prompt injection of Dexamethasone intramuscularly. Obviously, in these circumstances you should be seen and evaluated by a physician immediately. This might require that you visit your local emergency room for immediate attention. Flu-like illnesses associated with nausea and vomiting may require hospitalization to permit the intravenous administration of glucocorticoid hormones.

Management of steroids during hospitalization and at the time of medical procedures is usually directed by a physician. It is quite important that your physician be knowledgeable regarding the specifics of and indications for steroid therapy. Prompt and frequent communication between your physician and endocrinologist is of utmost importance. You, the patient, should make certain that your physician is aware that adjustments in glucocorticoid doses are required for moderately stressful procedures such as barium enemas, endoscopy, arteriography, and certain surgical procedures. Many patients refuse to undergo said procedures unless they can be certain that their physician has made arrangements to administer the appropriate dose of Hydrocortisone just before the procedure. Extra supplementation is generally not required for outpatient dental procedures performed under local anesthesia, minor surgical procedures under local anesthesia, and noninvasive radiological studies. If you have a question as to whether or not additional steroids are required, contact your physician or endocrinologist for further advice.
A Quick Reference For The Most Common Symptoms Of Adrenal Hormone Replacement
by Paul Margulies, M.D.

Most common symptoms of glucocorticoid (cortisol) deficiency : nausea, loss of appetite, Severe fatigue, weakness, weight loss, hyperpigmentation.

Most common symptoms of glucocorticoid (cortisol) excess: Weight gain, fatigue, easy bruising, muscle weakness, redness in the face, pink stretch marks, mood swings.

Most common symptoms of mineralocorticoid [fludrocortisone acetate (Florinef)] deficiency: Reduced blood pressure, dizziness on standing, salt craving, muscle cramps.

Most common symptoms of mineralocorticoid [fludrocortisone acetate (Florinef)] excess: Hypertension, ankle swelling, exertion headache.

NADF does not engage in the practice of medicine. It is not a medical authority, nor does it claim to have medical knowledge. In all cases, NADF recommends that you consult your own physician regarding any course of treatment or medication.