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Management of hypoadrenalism

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Management is directed towards rapid elevation of circulating glucocorticoid and replacement of salt and glucose loss.

By the General Practitioner:

  • hydrocortisone 100 mg im - effects last 6 hrs - or 100 mg iv - effects last 4 hrs, blood sample, immediate transfer to hospital

In hospital:

  • hydrocortisone 100 mg im or iv
  • 1 litre normal saline infused over 30-60 mins with 5% dextrose if hypoglycaemic; several litres may needed subsequently
  • continue hydrocortisone 6 hourly until the patient is stable - at this dose, no fludrocortisone is required because high cortisol exerts weak mineralocorticoid action
  • oral replacement may begin after 24 hours and be reduced to maintenance over 3-4 days
  • fludrocortisone may be introduced later

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