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Perspectives

Addison’s disease: managing ‘sick days’ to avoid crises

Marni A Nenke, David J Torpy

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Abstract

Integral to the body’s stress system, an increase in cortisol levels is critical to surviving illness. Timely administration of exogenous glucocorticoids in doses designed to mimic this response is essential in preventing an episode of adrenal insufficiency or crisis in patients who lack their own cortisol, such as in those with Addison’s disease.

Key Points

  • Glucocorticoid replacement should reflect physiological cortisol production.
  • Patients with adrenal insufficiency require additional supplementation in times of medical or surgical stress, with doses proportionate to the degree of the challenge severity.
  • The maximum daily production of cortisol during stress is 100 mg/m2 per day. Doses in excess of 200 to 300 mg hydrocortisone or equivalent glucocorticoid are unwarranted and have potential risks.
  • Education is key in preventing adrenal crises and is the responsibility of all medical practitioners.

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