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Addison’s Disease Treatment

Medications and How to Avoid an Addisonian Crisis

Treatment of Addison’s disease involves replacing the cortisol and/or aldosterone that your body is not able to produce—or that it secretes in an insufficient quantity. From your physical examination and tests, your endocrinologist or treating doctor will determine if you need one or both hormone replacements.

Cortisol is replaced with an oral synthetic glucocorticoid. The drug is taken one or two times each day. Generic drug names for glucocorticoids include hydrocortisone, prednisone, and dexamethasone. The goal is to give you the minimum amount of glucocorticoid needed to replace your body’s normal cortisol production—taking too much can cause its own problems, such as weight gain and even diabetes. 
 
Since cortisol is an important hormone for your body in times of stress and sickness, most people need to take two to three times their usual dose when they have a more severe illness, such as strep throat or stomach flu. If you have surgery or are hospitalized, your glucocorticoid dose will need to be increased further; your doctor will likely prescribe intravenous replacement. 
 
It’s a good idea to have an emergency dose of glucocorticoid at home that can be injected by you or a family member in the case that you are too sick to swallow pills.   
 
Aldosterone is replaced with an oral mineralcorticoid. The generic drug name is fludrocortisone. Your doctor may also recommend you increase your salt intake.
 
Whether one or both drugs are prescribed, your doctor will provide you with dosing instructions including how many pills to take each day, the best time to take the drug(s), and common side effects. He or she will closely monitor your symptoms to make sure your dose is sufficient—without giving you too much of the replacement hormone(s).
 
Important Medication Notes
  • It is important to take your medication as directed by your doctor. If you vomit up your medication or are too ill to take it, immediately contact your doctor.
  • If you have been diagnosed with adrenal insufficiency, you should wear a medical identification bracelet or necklace at all times should an emergency develop.
 
Addisonian Crisis Management and Prevention
Addisonian crisis (also called adrenal crisis) requires urgent medical attention, as it can be fatal.  Symptoms include dehydration, severe vomiting and diarrhea, loss of consciousness, low blood pressure, and/or stabbing pain in the abdomen, low back, or legs.
 
Treatment for Addisonian crisis may include intravenous injection of glucocorticoid, salt water (saline), and sugar (dextrose).
 
Your doctor will help you to identify signs, symptoms, and stressors that may trigger adrenal crisis. Always contact your doctor if you are worried that you might have an adrenal crisis. Sometimes, crisis can be averted with oral medication your doctor prescribes (i.e., prednisone or anti-nausea medicine). He or she will teach you when and how to give yourself an emergency glucocorticoid injection.
 
Outlook
While Addison’s disease is a rare but serious disorder, most patients live normal lives. Treatment—usually medications to boost cortisol hormone levels—is required life-long and can keep you feeling healthy.

 

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