# Adrenal insufficiency (Addison's disease) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: Adrenal Insufficiency - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK441832/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class TD99.01 - condition scope only, no dose · Endocrine Society Guideline for Hormonal Replacement in Adrenal Insufficiency 2016 · Egyptian National Drug Formulary - Endocrine System 2024 (fludrocortisone monograph) - Verified date: 2026-08 ## Verified against - Adrenal insufficiency (Addison's disease) - disease-level clinical article (adrenal-insufficiency-clinical.txt) - Endocrine Society Guideline for Hormonal Replacement in Adrenal Insufficiency 2016 - Egyptian National Drug Formulary - Endocrine System 2024 (fludrocortisone monograph) - Adrenal Insufficiency - disease-level clinical article (adrenal-insufficiency-referral-clinical.txt) ## Treatment metadata - Hydrocortisone — 10 mg — oral.solid - Referral & safety-netting (no drug therapy) - Prednisone — oral.solid - Fludrocortisone — 0.1 mg — oral.solid ## Complete treatment card ```text ADRENAL INSUFFICIENCY (ADDISON'S DISEASE) Sources: Adrenal Insufficiency - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK441832/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class TD99.01 - condition scope only, no dose · Endocrine Society Guideline for Hormonal Replacement in Adrenal Insufficiency 2016 · Egyptian National Drug Formulary - Endocrine System 2024 (fludrocortisone monograph) Review status: REVIEWED against Adrenal insufficiency (Addison's disease) - disease-level clinical article (adrenal-insufficiency-clinical.txt), Endocrine Society Guideline for Hormonal Replacement in Adrenal Insufficiency 2016, Egyptian National Drug Formulary - Endocrine System 2024 (fludrocortisone monograph), Adrenal Insufficiency - disease-level clinical article (adrenal-insufficiency-referral-clinical.txt) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (5) - Low blood pressure, confusion, loss of appetite, vomiting, weight loss, and tiredness [confusion · fatigue · hypotension · poor appetite · vomiting · weight loss] - Women may report missed periods, low libido, and loss of underarm and pubic hair - Craving salty foods and feeling lightheaded on standing are common in the primary form [dizziness] - A history of taking steroid medication is an important clue, especially in longstanding cases - Fever can occur in any type and should prompt a search for an infection [fever] SIGNS - what you find (4) - Poor skin turgor and darkened skin pigmentation can be seen on exam [dehydration] - Look also for Cushingoid features - thin skin, stretch marks, swelling, weight gain, and muscle wasting [muscle wasting · stretch marks · weight gain] - Up to half of patients go into shock without any preceding drop in blood pressure [shock] - Neuropsychiatric changes can be part of the exam picture TESTS (7) - Low sodium with high potassium and low blood sugar can appear on chemistry - Cortisol, ACTH, renin, and aldosterone levels should be drawn along with a chemistry panel - An ACTH stimulation test distinguishes a primary (adrenal) cause from a secondary (pituitary) one - Anti-21-hydroxylase antibodies are the first test to check, since they cause the autoimmune destruction of the adrenal cortex - The secondary form causes low blood sugar but not dehydration, high potassium, or skin darkening - HIV and tuberculosis testing should be considered when the cause of late-onset disease is unclear - Anemia, low sodium, and high potassium are the most frequent lab findings in the chronic primary form IF NOT THIS - what else fits (5) - Adrenal crisis and adrenal hemorrhage are on the differential - Congenital adrenal hyperplasia should be considered - Histoplasmosis is a fungal infection that belongs on the list - Sarcoidosis, a granulomatous disease, is a differential too - Tuberculosis is a differential, especially relevant in developing countries Source StatPearls "Adrenal Insufficiency" - disease-level clinical article Status traced to the source above 1. HYDROCORTISONE [1st line] Adult 15-25 mg daily in divided doses (e.g. 10 mg on waking, 5 mg at midday, 5 mg early afternoon to replicate physiological cortisol rhythm) - long-term lifelong Peds 8-10 mg/m2/day in 3 divided doses under pediatric endocrinologist management Source Endocrine Society Guideline for Hormonal Replacement in Adrenal Insufficiency 2016 Why Physiological glucocorticoid replacement for adrenal insufficiency, timed across the day to mimic the body's own cortisol rhythm since the adrenal glands can no longer produce it; lifelong replacement rather than anti-inflammatory treatment. Caution MUST DOUBLE or TRIPLE dose during intercurrent illness, fever, or acute stress ('sick- day rules'). Issue steroid emergency card and self-injectable hydrocortisone emergency kit. Avoid late evening doses to prevent insomnia. Egypt has no registered oral hydrocortisone. The only pack in the register is an unlicensed import at around 66 EGP, and it is shown because it is the only thing there - not because it is a reliable supply. In a disease where running out means an adrenal crisis, that is the single most important practical fact about this prescription. So plan the supply before it is needed: confirm the patient can actually obtain the next box, keep a margin in hand rather than filling at the last tablet, and agree in advance what they do if the pharmacy cannot get it. Whether to replace it with an equivalent dose of a registered steroid is a decision for the treating physician, and it should be made at a clinic visit, not in the middle of an illness. Egypt HYDROCORTISONE ROUSSEL 10MG 25 TABS.(ILLEGAL IMPORT) SANOFI > 66.00 EGP (2.64/unit) 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Addison's disease and secondary adrenal insufficiency occur and are life-threatening if missed; the GP recognises symptoms, may give an emergency steroid, and refers to endocrinology for long-term management. Peds Children follow the same pathway: recognise and refer. Replacement steroid doses are started and titrated by a paediatric endocrinologist. Source Adrenal Insufficiency - disease-level clinical article (adrenal-insufficiency-referral- clinical.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution Adrenal crisis - low blood pressure, vomiting, collapse - is a medical emergency requiring immediate parenteral steroid and hospital transfer. 3. PREDNISONE [2nd line] Adult Prednisone 5 mg (2.5 to 7.5 mg) orally at bedtime - long-term lifelong Peds The source gives no paediatric prednisone dose for maintenance replacement; its only prednisone maintenance dose is the adult one above. A child's replacement steroid is hydrocortisone 8-10 mg/m2/day in 3 divided doses, started and titrated by a paediatric endocrinologist. Source Adrenal Insufficiency (Addison's Disease - Maintenance) - disease-level clinical article (adrenal-insufficiency-referral-clinical.txt) Why Alternative longer-acting oral glucocorticoid replacement for chronic primary adrenal insufficiency. Caution MUST DOUBLE or TRIPLE dose during intercurrent illness, fever, or acute stress ('sick- day rules'). Issue steroid emergency card and self-injectable hydrocortisone emergency kit. Egypt HOSTACORTIN 5MG 30 TAB. SANOFI AVENTI... 12.00 EGP (0.40/unit) 4. FLUDROCORTISONE [add-on - not a substitute] Adult 50-200 mcg (0.05-0.2 mg) once daily in the morning for mineralocorticoid replacement in primary adrenal insufficiency - long-term lifelong Peds 50-150 mcg daily under pediatric endocrinologist care Source Egyptian National Drug Formulary - Endocrine System 2024 (fludrocortisone monograph) Why Synthetic mineralocorticoid that replaces the aldosterone activity lost in primary adrenal insufficiency, helping maintain sodium and potassium balance; added to glucocorticoid replacement rather than used alone, and needed only when the adrenal failure is primary. Caution Required in primary adrenal insufficiency (Addison's); not required in secondary adrenal failure. Monitor blood pressure, serum potassium, and plasma renin activity. Egypt ASTONIN-H 0.1MG 30 TAB. AMOUN > MERCK... 18.00 EGP (0.60/unit) CORTILON 0.1 MG 20 TAB. AMOUN 16.00 EGP (0.80/unit) Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)