Primary adrenocortical insufficiency: Diagnosis & Treatments
Diagnosis
The most important diagnosis is the rapid ACTH stimulation test. This is a screening test to measure plasma cortisol and aldosterone 30-60 minutes after the administration of 250 ug of synthetic ACTH. Normal criteria were cortisol> 18 ug / dL or more than 7 ug / dL, aldosterone> 5 ng / dL or more. In the case of primary insufficiency, both cortisol and aldosterone did not respond. In case of secondary insufficiency, there was no cortisol response and aldosterone response was normal. Confirmatory test is a standard (prolonged) ACTH stimulation test, and continuous 24hr infusion is performed and measured. In addition, plasma ACTH levels are helpful for diagnosis. In the case of primary, the ACTH level is over 250 pg / mL, and in the case of secondary, it is in the range of 0-50 pg / mL.
Treatments
Treatment is hormone replacement. Primary adrenal insufficiency should supply both glucocorticoids and mineralocorticoids. Secondary adrenal insufficiency should be supplemented with glucocorticoids. In women, administration of DHEA, an androgen, may also be considered, which may improve quality of life and bone mineral density.
Glucocorticoid is a drug of choice and hydrocortisone is also a cortisone and prednisone. Prednisolone and dexamethasone are not preferred because they work long. For normal diurnal rhythm stimulation, administer 2/3 in the morning and 1/3 in the late afternoon. In the case of severe stress such as fever, surgery or trauma, the dose should be increased.
The above mentioned glucocorticoids also contain mineralocorticoids, but this alone is insufficient, so primary adrenal insufficiency supplement mineralocorticoids after 4-5 days of glucocorticoid treatment. Fludrocortisone can be supplemented, and sodium should also be taken at 3-4 g / day. Blood pressure, electrolyte, and BUN can be measured to assess the adequacy of treatment.
The most important diagnosis is the rapid ACTH stimulation test. This is a screening test to measure plasma cortisol and aldosterone 30-60 minutes after the administration of 250 ug of synthetic ACTH. Normal criteria were cortisol> 18 ug / dL or more than 7 ug / dL, aldosterone> 5 ng / dL or more. In the case of primary insufficiency, both cortisol and aldosterone did not respond. In case of secondary insufficiency, there was no cortisol response and aldosterone response was normal. Confirmatory test is a standard (prolonged) ACTH stimulation test, and continuous 24hr infusion is performed and measured. In addition, plasma ACTH levels are helpful for diagnosis. In the case of primary, the ACTH level is over 250 pg / mL, and in the case of secondary, it is in the range of 0-50 pg / mL.
Treatments
Treatment is hormone replacement. Primary adrenal insufficiency should supply both glucocorticoids and mineralocorticoids. Secondary adrenal insufficiency should be supplemented with glucocorticoids. In women, administration of DHEA, an androgen, may also be considered, which may improve quality of life and bone mineral density.
Glucocorticoid is a drug of choice and hydrocortisone is also a cortisone and prednisone. Prednisolone and dexamethasone are not preferred because they work long. For normal diurnal rhythm stimulation, administer 2/3 in the morning and 1/3 in the late afternoon. In the case of severe stress such as fever, surgery or trauma, the dose should be increased.
The above mentioned glucocorticoids also contain mineralocorticoids, but this alone is insufficient, so primary adrenal insufficiency supplement mineralocorticoids after 4-5 days of glucocorticoid treatment. Fludrocortisone can be supplemented, and sodium should also be taken at 3-4 g / day. Blood pressure, electrolyte, and BUN can be measured to assess the adequacy of treatment.
