There are different treatment protocols depending on the nature of the insufficiency.
Adrenal Crisis is a life-threatening emergency that requires immediate treatment.
The first stage is to treat the hypotension (low blood pressure) and correct the electrolyte abnormalities. Large volumes (2-3 litres) of saline (or dextrose in saline) should be given intravenously without delay. Hydrocortisone (converted by the body to cortisol) is immediately injected intravenously to replace the cortisol. After the initial management, the precipitating cause can be treated. In primary adrenal insufficiency, mineralocorticoid replacement using fludrocortisone, is also given when the patient is stable.
The patient's own management of the disease is the key to successful treatment. At all times a medical alert bracelet should be worn with an emergency medical card indicating the diagnosis and daily medications. The patient can lead a normal active life, but must take precautions against an emergency situation.
The aim of the therapy is to replace the glucocorticoids (with hydrocortisone or dexamethasone) and in some cases mineralocorticoids (with fludrocortisone). Higher doses of glucocorticoids are given during times of illness or major stress (e.g. surgery).
The treatment of secondary and tertiary adrenal insufficiency is identical to that of primary adrenal insufficiency except that mineralocorticoid replacement is rarely required.
A recent study has shown that patients with Addison's disease have abnormally low levels of DHEAS and androgens relative to their age. The study has shown that a daily replacement of the steroids is possible without severe side effects.