Key Treatment

In primary adrenal insufficiency, long-term glucocorticoid and mineralocorticoid replacement is necessary. Baseline steroid dose should be increased twofold to threefold during febrile illness or injury (Arlt and Allolio, 2003; Oelkers, 1996; Salvatori, 2005) (SOR: A). Therapeutic intervention for secondary and tertiary adrenal insufficiency requires treatment of underlying disorders. Glucocorticoid replacement is necessary (Arlt and Allolio, 2003; Oelkers, 1996; Salvatori, 2005) (SOR: A).

Oral fludrocortisone (0.05-0.20 mg daily) is the treatment of choice for aldosterone deficiency. In hyporeninemic hypoaldosteronism, furosemide with reduced salt intake can ameliorate acidosis and hyperkalemia (Arlt Allolio, 2003; Oelkers, 1996) (SOR: A). Surgical resection is usually the treatment of choice for Cushing's disease and ACTH-independent Cushing's syndrome (Nieman et al., 2009) (SOR: A).

Treatment of aldosteronism is directed at the underlying cause. Aldosterone antagonists such as spironolactone are effective therapy (Funder et al., 2008) (SOR: A). Laparoscopic removal of intra- and extra-adrenal pheochromocytomas after alpha-adrenoceptor blockade is the preferred treatment (Lenders et al., 2005) (SOR: A). Treatment of congenital adrenal hyperplasia with glucocorticoids may result in amelioration of symptoms (New, 2004) (SOR: A).

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