Adrenal insufficiency: Difference between revisions
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*Infectious |
*Infectious |
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**[[Tuberculosis]] |
**[[Tuberculosis]] |
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**[[Neisseria meningitidis|Meningococcemia]] causing [[ |
**[[Neisseria meningitidis|Meningococcemia]] causing [[Waterhouse-Friderichsen syndrome]] |
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**[[HIV medications|HIV]], [[CMV in pregnancy|CMV]] |
**[[HIV medications|HIV]], [[CMV in pregnancy|CMV]] |
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**[[Histoplasmosis]] |
**[[Histoplasmosis]] |
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Latest revision as of 16:01, 6 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
