Question: What changes should be made to replacement medications during illness? Answer: For minor febrile illnesses, like the flu or other viral illness, use the “three for three” rule. This can be done without notifying your endocrinologist. Increase your dosage to three times the maintenance dosage for three days, while doing all the other things… Continue Reading
Author Archives: kkc
Steroid Replacement and a 24hr Urinary Cortisol Test
Question: Does a 24-hour urinary cortisol measurement give any information on whether a patient without any adrenal glands is taking the correct amount of replacement hydrocortisone? Are there other tests that can be used to determine the correct replacement dose? Answer: For the most part, adequacy of the hydrocortisone (glucocorticoid) dose is judged by clinical… Continue Reading
Discontinuing Steroid Replacement After Adrenal Surgery
Question: I had Cushing’s due to an adrenal tumor and from what I’m told, no longer require replacement medication. My 8 AM ACTH is elevated and very variable and my 8 AM cortisol levels vary as well. Should this be a concern? Does the variability have anything to do with how tired I am? Should… Continue Reading
Different Steroid Replacement Medications
Question: What are the differences between hydrocortisone, cortisone acetate, prednisone, and dexamethasone? Are there any guidelines as to when one is used versus another? Answer: These compounds are all adrenal steroid analogs; specifically, they are called glucocorticoids. Glucocorticoids affect carbohydrate, protein, and fat metabolism, bone metabolism, and immune and inflammatory functions. In contrast, the mineralocorticoid… Continue Reading
Determination of Replacement Steroid Dose
Question: How is the proper dosage of maintenance medication determined? Answer: Your endocrinologist begins with a “standard” dosage of steroid, which lies within a very narrow range. For an average adult, the usual daily dosage for glucocorticoid replacement would be .5 to .75 mg of dexamethasone taken as a single dose, 5 to 7.5 mg… Continue Reading
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