Principles of managing adrenal insufficiency

Adrenal insufficiency should be managed under specialist guidance; the aim of treatment is to correct hormone deficiency. Catecholamines do not need to be replaced in adrenal insufficiency, as they are also produced by the sympathetic nervous system.

Primary adrenal insufficiency requires lifelong glucocorticoid and mineralocorticoid replacement. Androgen replacement is not routinely required; see Androgen replacement for adrenal insufficiency for more information.

Adrenal insufficiency secondary to hypopituitarism only requires glucocorticoid replacement; mineralocorticoid replacement is not required because the renin–angiotensin–aldosterone axis remains intact.

During a significant systemic illness or a surgical procedure, the dose of glucocorticoid therapy must be increased to simulate the normal increase in cortisol secretion in response to stress. See Glucocorticoid replacement during intercurrent illness and surgery for more information. It is crucial that the patient or their carer is able to manage glucocorticoid dose adjustments during illness; see patient education.

Before and during treatment of adrenal insufficiency, consider concurrent drugs that could affect steroid replacement dose requirements; see drugs that affect steroid dose requirements.

A patient with adrenal insufficiency and coexisting elevated blood pressure or heart failure may require a lower mineralocorticoid dose than other patients. See Hypertension and heart failure associated with adrenal insufficiency for information about management.

Children with adrenal insufficiency related to a genetic disorder should be monitored for associated neurological and gonadal disorders. For adrenal insufficiency that is part of an autoimmune polyglandular syndrome, monitor the child for other endocrinopathies.