What medications are used to treat adrenal insufficiency in congenital adrenal hyperplasia (CAH)?

Updated: Oct 06, 2020
  • Author: Thomas A Wilson, MD; Chief Editor: Sasigarn A Bowden, MD  more...
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Answer

In patients who are sick and who have signs of adrenal insufficiency, therapy should consist of stress dosages of hydrocortisone (50-100 mg/m2 or 1-2 mg/kg IV administered as an initial dose), followed by 50-100 mg/m2/d IV divided every 6 hours. Comparable stress dosages include 10-20 mg/m2 of methylprednisolone administered IV or intramuscularly (IM) and 1-2 mg/m2 of dexamethasone. Methylprednisolone and dexamethasone have negligible mineralocorticoid effects. Therefore, if the patient is hypovolemic, hyponatremic, or hyperkalemic, large dosages of hydrocortisone (double or triple the stress dosages mentioned above) are preferred because of its mineralocorticoid effect.


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