Adrenal insufficiency: Difference between revisions
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*Inflammatory/Autoimmune |
*Inflammatory/Autoimmune |
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**Primary autoimmune |
**[[Primary adrenal insufficiency|Primary (autoimmune) adrenal insufficiency]] |
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**[[Sarcoidosis]] |
**[[Sarcoidosis]] |
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**[[Antiphospholipid syndrome]] |
**[[Antiphospholipid syndrome]] |
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Revision as of 01:39, 3 March 2021
Differential Diagnosis
- Inflammatory/Autoimmune
- Infectious
- Malignancy
- Metastases, especially breast cancer
- Other
- Systemic anticoagulation
- Adrenoleukodystrophy
Management
- Treat with dexamethasone while awaiting result of ACTH stimulation test to confirm diagnosis
- At 1h after ACTH, cortisol should be above 550 and have increased by 250
- Stress dosing, to be given for 24h unless ongoing illness
- Hydrocortisone 300mg (divided q8h)
- Prednisone 60mg
- Methylprednisolone 50mg
- Dexamethasone 8mg
- After stress dosing, can deescalate quickly to physiologic doses
- Prednisone 7.5mg daily or 5mg/2.5mg split, with fludrocortisone 0.1mg daily
- Hydrocortisone 20mg/10mg split, without fludrocortisone
- For future stress dosing during intercurrent illnesses, can simply double dose when febrile
