Mineralocorticoid replacement for adrenal insufficiency

The aims of mineralocorticoid therapy for adrenal insufficiency are to maintain:

• normal blood pressure (to avoid syncope)
• serum sodium and potassium concentrations in the normal range
• plasma renin concentration at the upper end of the normal range.

A moderately elevated plasma renin concentration is common and is acceptable if symptoms are well controlled. A low plasma renin concentration suggests overtreatment.

For mineralocorticoid replacement for adrenal insufficiency in an adult, use:

The dose requirement of fludrocortisone in children varies significantly—it should be started and titrated by a specialist. The usual maintenance dose in a child is:

Infants may need a higher fludrocortisone dose in the first few months of life.

Acute adjustment of the mineralocorticoid dose is not required for stress or intercurrent illness.