Hydrocortisone (Cortef) is a synthetic glucocorticoid medication that replaces lost cortisol. Doses vary based on patient weight and metabolism, typically 20-50 mg. Remember to assess for signs and symptoms of Cushing’s syndrome, as these patients will take these medications throughout the duration of their lives and may require dosage adjustment. Always gradually taper glucocorticoid medications as exogenous medications suppress ACTH.
In the normal body cortisol levels peak in the morning and as such patients can take their entire daily dose of hydrocortisone in the morning, immediately after waking. If this schedule results in afternoon or evening fatigue, patients may split the dosage, taking two-thirds in the morning.
The remaining one-third of the daily dose of hydrocortisone can be given around 4:00 in the afternoon in an attempt to mimic the body’s rhythmic release of cortisol.
Fludrocortisone (Florinef) is a synthetic mineralocorticoid medication that is taken in the morning daily. It is administered additionally to patients lacking aldosterone for sodium retention and potassium excretion in the kidney. Remember to assess for hypertension and fluid overload from excessive sodium retention.
The adrenal cortex produces androgens and replacement therapy is needed especially in females. This may only be needed in serious conditions.
Salt additives must be supplemented in patients because patients are unable to retain sodium naturally, especially during periods of salt loss like sweating with exercise and in hot temperatures.
During periods of stress or infection dosages of medications like hydrocortisone may need to be increased as the body’s metabolic demands are increased. Likewise, with strenuous exercise or in times of increased sweating, additional salt intake will be required to maintain homeostasis.
A bracelet can allow emergency personnel to quickly identify the patient’s needs in the event the patient is unconscious or unable to communicate.
Patients will require hormone replacement therapy for the duration of their lifetimes as there is no cure for this disease.
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