Adrenal insufficiency
Reduced synthesis of adrenal cortex hormones: glucocorticoids, mineralocorticoids and androgens. May be primary (Addison disease) or secondary due to pituitary disorders.
ICD-10 E273 drugs
Also known as: Addison disease, Hypocortisolism
Drugs used for this condition
- AFludrocortisoneFirst line · Systemic mineralocorticoidFludrocortisone covers the mineralocorticoid half of replacement therapy in primary adrenal insufficiency. Hydrocortisone answers the glucocorticoid deficit but cannot hold sodium and blood volume, and without the second drug the weakness, salt craving, dizziness on standing and high potassium remain. The AEMPS Astonin label frames the indication as mineralocorticoid replacement in primary and secondary adrenal insufficiency, naming Addison disease and salt-wasting congenital adrenal hyperplasia. The dose is titrated to supine and standing blood pressure, potassium, sodium and plasma renin rather than to how the patient feels: early on, both too much and too little look equally non-specific. In hot weather, with exercise and sweating, the salt requirement rises, and that is covered separately.
- AHydrocortisoneFirst line · Short-acting systemic glucocorticoid, identical to endogenous cortisolReplacement therapy for primary (Addison) and secondary adrenal insufficiency. SEEN recommends hydrocortisone 15–25 mg/day in 2–3 doses with the larger dose in the morning to mimic the circadian rhythm. Double or triple the dose during intercurrent illness (fever, surgery).
- BDehydroepiandrosterone (DHEA, prasterone)Add-on therapy · Endogenous C19 steroid precursor; an EU prescription drug for adrenal insufficiency and a vaginal form (Intrarosa); a freely available supplement in the United StatesDHEA replaces adrenal androgen deficiency in women with Addison disease and secondary adrenal insufficiency. The Endocrine Society 2014 and SEEN 2022 frame DHEA as an optional add-on for persistent low mood and reduced libido after full glucocorticoid and mineralocorticoid replacement. Dose 25–50 mg in the morning. Men with adrenal insufficiency do not need DHEA: testicular testosterone covers the deficit. If DHEA was prescribed with preserved adrenal function, consider seeking a second endocrinologist opinion.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit