What're the treatments for Addison's disease?
Treatment for Addison's disease involves replacing the missing cortisol and, if necessary, providing replacement therapy for the missing aldosterone. Caution must be exercised when the person with Addison's disease has surgery or becomes
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Since all of the manifestations of Addison's disease are caused by the lack of cortisol and aldosterone, the treatment is to replace these with similar steroids. Cortisol is usually replaced orally by cortisone acetate or hydrocortisone tablets divided into morning and afternoon doses. Aldosterone is replaced by an aldosterone-like synthetic steroid, fludrocortisone (Florinef) tablets given once daily. The doses of each of these medications are adjusted for the individual's size and any co-existing medical conditions. In emergencies or during surgery, hydrocortisone must be given intravenously. Patients with Addison's disease should be taught to treat minor illnesses with extra salt and fluids. This is especially important if fever, vomiting or diarrhea is present. Persistence of these signs requires immediate treatment in an emergency room with intravenous saline (salt water) and hydrocortisone. Since Addison's disease is a chronic condition, daily replacement medication can never be stopped.
In the case of Addisonian crisis, this will be achieved by injecting a potent form of steroid preparation through a needle placed in a vein (intravenous or IV). Dehydration and salt loss will also be treated by administering carefully balanced solutions through the IV. Dangerously low blood pressure may require special medications to safely elevate it until the steroids take effect.
Patients with Addison's disease will need to take a steroid preparation (hydrocortisone) and a replacement for aldosterone (fludrocortisone) by mouth for the rest of their lives. When a patient has an illness which causes nausea and vomiting (such that they cannot hold down their medications), he or she will need to enter a medical facility where IV medications can be administered. When a patient has any kind of infection or injury, the normal dose of hydrocortisone will need to be doubled.
During an addisonian crisis, low blood pressure, low blood sugar, and high levels of potassium can be life threatening. Standard therapy involves intravenous injections of hydrocortisone, saline (salt water), and dextrose (sugar). This treatment usually brings rapid improvement. When the patient can take fluids and medications by mouth, the amount of hydrocortisone is decreased until a maintenance dose is achieved. If aldosterone is deficient, maintenance therapy also includes oral doses of fludrocortisone acetate. |
