How is glucocorticoid maintenance dosing for the treatment of pediatric adrenal insufficiency (Addison disease) monitored?

Updated: Dec 07, 2018
  • Author: Kimberly Tafuri, DO; Chief Editor: Sasigarn A Bowden, MD  more...
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Answer

Individualize the maintenance dosage for each patient. The range for hydrocortisone is 7-20 mg/m2/d given orally in 2 or 3 divided doses.

Monitor the adequacy of dosing in patients with adrenal insufficiency who receive long-term glucocorticoid therapy, and adjust the dose of glucocorticoid for each patient on the basis of clinical criteria (eg, absence of symptoms of glucocorticoid deficiency, excessive weight gain and normal growth). Too little glucocorticoid causes symptoms of adrenal insufficiency. Too much glucocorticoid causes excessive weight gain, cushingoid features, hypertension, hyperglycemia, cataracts, and growth failure. In children, growth failure is a sensitive indicator of exposure to excessive glucocorticoids.

In the authors' experience, plasma adrenocorticotropic hormone (ACTH) concentrations provide little guidance for adjusting doses of glucocorticoids. Growth pattern and symptoms of salt craving, blood pressure, plasma renin activity, and electrolytes help in adjusting doses of fludrocortisone.


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