During minor illness (., flu or fever >38° C [° F]) the hydrocortisone dose should be doubled for 2 or 3 days. The inability to ingest hydrocortisone tablets warrants parenteral administration. Most patients can be educated to self administer hydrocortisone, 100 mg IM, and reduce the risk of an emergency room visit. Hydrocortisone, 75 mg/day, provides adequate glucocorticoid coverage for outpatient surgery. Parenteral hydrocortisone, 150 to 200 mg/day (in three or four divided doses), is needed for major surgery, with a rapid taper to normal replacement during the recovery. Patients taking more than 100 mg hydrocortisone/day do not need any additional mineralocorticoid replacement. All patients should wear some form of identification indicating their adrenal insufficiency status.
In the ., the most common cause (about 75%) of primary adrenal insufficiency in adults is an autoimmune process. It may occur with other autoimmune conditions that affect other glands, such as the thyroid. The rest of the time, Addison disease is due to other causes, such as tuberculosis , a common cause in areas of the world where tuberculosis is more prevalent , other chronic infections, especially fungal infections , bleeding into the adrenal glands ( hemorrhage ) and the spread of cancer into the adrenal glands. Rarely, it may be due to a genetic abnormality of the adrenal glands.
Causes of primary adrenal insufficiency (Addison's disease)
Causes of secondary and tertiary adrenal insufficiency in adults
Clinical manifestations of adrenal insufficiency in adults
Diagnosis of adrenal insufficiency in adults
Evaluation of the response to ACTH in adrenal insufficiency
Hyponatremia and hyperkalemia in adrenal insufficiency
Pathogenesis of autoimmune adrenal insufficiency
Treatment of adrenal insufficiency in adults
Treatment of adrenal insufficiency in children