Inpharma 1321 - 19 Jan 2002

Corticosteroid supplementation inadrenal insufficiency

Corticosteroid supplementation for adrenalinsufficiency (AI) is an area of importance but is poorlyunderstood, say Drs Douglas Coursin and KennethWood from the University of Wisconsin-MadisonMedical School, US.

AI, most commonly caused by exogenouscorticosteroid administration, is becoming increasinglycommon. Despite this, the appropriate regimen forcorticosteroid supplementation during acute stress isunclear. In the past, clinicians have tended to use dosesof both excessive amount and duration, according toDrs Coursin and Wood. They say that for patients withprimary AI, maintenance replacement should beindividualised and many experts currently recommendthe use of longer-acting corticosteroids such asdexamethasone 0.5 mg/day or prednisone 5 mg/day.These patients are hypoaldosteronemic, andfludrocortisone is usually given orally at a dosage of0.05–0.2 mg/day.

During times of stress, maintenance supplementationis continued. Drs Coursin and Wood note that, based ontwo recent reviews, those patients with AI caused byexogenous corticosteroid administration receiving theequivalent of prednisone ≤ 5 mg/day do not requireadditional supplementation. Additionalsupplementation for those receiving higher dosagesdepends on the severity of stress. For example, thoseundergoing a minor procedure should receive anadditional 25mg of hydrocortisone or 5mg ofmethylprednisolone on the day of the procedure only.By comparison, those with septic shock should receiveIV hydrocortisone 50–100mg every 6–8 hours (or 0.18mg/kg/h by continuous infusion) with fludrocortisone 50µg/day until the shock is resolved.

Finally, the role of corticosteroid replacement inpatients without pre-existing AI who are severely ill isbeing investigated in current trials, comment DrsCoursin and Wood.Coursin DB, et al. Corticosteroid supplementation for adrenal insufficiency.JAMA: the Journal of the American Medical Association 287: 236-240, 9 Jan2002 800896054

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Inpharma 19 Jan 2002 No. 13211173-8324/10/1321-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved