Description

Glucocorticoid replacement therapy is essential for all forms of hypoadrenalism. This includes pituitary and hypothalamic disease causing ACTH deficiency (numerically the most common in my practice and usually due to a pituitary tumour) and primary adrenocortical failure (most commonly due to Addison’s disease or bilateral adrenalectomy) and in both these situations the aim is to replace the circulating steroid levels which are low as the result of the disease process. In some other situations, such as congenital adrenal hyperplasia, the aim is both to replace missing glucocorticoids and to suppress the secretion of adrenal steroid precursors, primarily to avoid their androgenic effects. In the latter situation, many clinicians would advocate longer-acting synthetic glucocorticoids such as prednisolone or dexamethasone to maximise the time-course of suppression, but in all other instances replacement with hydrocortisone, the generic pharmaceutical name for cortisol, is usually recommended. Patients with primary adrenocortical failure usually also require mineralocorticoid replacement using fludrocortisone.