Management is directed towards rapid elevation of circulating glucocorticoid and replacement of salt and glucose loss. (1,2)
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
Seek expert advice:
- 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
Reference
- Husebye ES, Pearce SH, Krone NP, et al. Adrenal insufficiency. Lancet. 2021 Feb 13;397(10274):613-29.
- Bancos I, Hahner S, Tomlinson J, Arlt W. Diagnosis and management of adrenal insufficiency. Lancet Diabetes Endocrinol. 2015 Mar;3(3):216-26