Long-term management of patients after adrenalectomy

Experience with the long-term medical management of 17 patients previously subjected to surgical adrenalectomy was reviewed. Maintenance adrenal cortical replacement requirements consisted of oral cortisone, 37.5 to 50 mg. daily in all patients; desoxycorticosterone acetate (DOCA), 2 mg. daily, sublingually in all patients; and supplemental sodium chloride, 1 to 4 grams daily, in seven patients. This provides steroids with glucocorticoid and mineralocorticoid activity and an adequate salt intake. The subjective well-being of the patient was the best indicator of adequate replacement therapy. Under stable conditions, established dosage schedules required surprisingly little adjustment over long periods of time. The primary need of patients without adrenal glands when they are subjected to such stresses as infections, trauma or surgical operation, is for more glucocorticoids. Ordinarily, more DOCA and extra sodium chloride is not required. Mild infections can be dealt with by temporarily increasing the daily oral cortisone requirement, the patient remaining ambulatory. Severe infections with pronounced systemic manifestations require hospitalization and parenteral administration of glucocorticoids. Knowing how long it takes for the various glucocorticoid preparations to take effect and how long they continue to act is important in the management of patients who have had adrenalectomy, particularly in dealing with extraordinary stresses or emergencies.