4th April 2024

Management

This consists of glucocorticoid and mineralocorticoid replacement with hydrocortisone and fludrocortisone, respectively. During times of stress e.g., infection or surgery, there will be greater physiological demand for cortisol and patients should be educated to double their glucocorticoid dose. Medical alert bracelets detailing Addison’s disease can be helpful in ensuring prompt treatment is administered in the event of an Addisonian crisis.

Management of the Addisonian crisis involves replacing cortisol with IV hydrocortisone. Further treatment may involve fluid resuscitation, blood glucose control, optimisation of blood pressure and replacement of electrolytes and adrenal hormones. This may require admission to an intensive care unit and care must be taken to avoid rapid fluid shifts as patients are likely to be hyponatremic on presentation.