Dermatologic Aspects of Addison Disease Medication

Updated: Jul 18, 2017
  • Author: Elizabeth A Liotta, MD; Chief Editor: William D James, MD  more...
  • Print
Medication

Medication Summary

With optimum dosing (which is often a challenge), the glucocorticoids are adequately replaced with minimal adverse effects. Underdosing of glucocorticoids results in continued adrenal insufficiency. In children, nocturnal hypoglycemia can result in seizures. Overdosing of glucocorticoids results in weight gain, increased blood pressure, and osteoporosis. The effects of steroid replacement are assessed with clinical examination.

The resolution of symptoms and the correction of electrolyte abnormalities are the customary signals in determining the adequacy of replacement. In patients at risk for osteoporosis, monitor serum and urine cortisol levels; this method appears to be the best available assessment of steroid dosing.

The titration of mineralocorticoid replacement is achieved by monitoring electrolyte levels and plasma rennin concentrations and by evaluating clinical findings such as dizziness or weight gain. Weakness, decreased diastolic blood pressure, low serum sodium levels, and increased plasma rennin concentrations occur with an underdosing of fludrocortisone. Overdosing is difficult to determine. Decreased serum potassium levels may be seen. Increased levels of atrial natriuretic peptide have been proposed to be more accurate in determining an overdose. [13]

Some cases of multifocal disseminated lipoatrophy as a result of intravenous corticosteroid administration have been reported in these patients with adrenal insufficiency. [14]

Next:

Corticosteroids

Class Summary

These agents are used to restore corticosteroid levels.

Cortisone (Cortone)

Cortisone is a drug of choice for patients with adrenocortical insufficiency.

Hydrocortisone (Hydrocortone, Cortef)

Hydrocortisone is a drug of choice because of its mineralocorticoid activity and glucocorticoid effects. Some cases of multifocal disseminated lipoatrophy as a result of intravenous corticosteroid administration have been reported in these patients with adrenal insufficiency.

Fludrocortisone (Florinef)

Fludrocortisone is used for partial replacement therapy in primary and secondary adrenocortical insufficiency.

Dexamethasone (Decadron, Baldex, Dexone)

Dexamethasone is a drug of choice for patients with adrenocortical insufficiency.

Previous