Assessment of glucocorticoid replacement therapy

Glucocorticoid replacement is essential for all forms of hypoadrenalism and hydrocortisone (cortisol) is the preferred drug for replacement. This article describes a simple regime for monitoring hydrocortisone replacement: therapy and reviews the results of such assessments in the author's department and in the literature. Thrice daily hydrocortisone is recommended, with a usual starting dose of 10 mg on rising, 5 mg at lunchtime, and 5 mg evening, because traditional twice daily regimes more frequently result in elevated morning plasma cortisol and 24 hour urine free cortisol despite persistently low plasma cortisol before the evening dose, which may be associated with nonspecific symptoms at this time. Possible adverse effects of suboptimal glucocorticoid replacement are discussed.