[Adrenal insufficiency and treatment with glucocorticosteroid]

Lately, it has been revealed that cortisol (hydrocortisone) secretion is lower than previously thought. Replacement doses of 10-15 mg/24 h seem sufficient in non-obese individuals. The day-night variation and in particular the fast oscillations in plasma cortisol concentration may be important for the patient's well-being. The lack of these fluctuations may explain why quality of life in some patients is unsatisfactory despite seemingly adequate substitution. It has been assumed that critical disease and stress such as major surgery require increased doses of hydrocortisone. Recently, this notion has been questioned, and in many patients with serious diseases the amount of hydrocortisone secreted is not increased. At present, there is no documentation for the benefit of high doses (100-400 mg hydrocortisone) in patients with critical disease and adrenal insufficiency.