Adrenal insufficiency prevention

To Prevent Hypocortisolism and Development of Adrenal Insufficiency or Adrenal Crisis... 

Mitotane—if well-tolerated, dose may be doubled on day 3 then, from day 5 onwards, may increase dose by 500 mg every 2-3 days until maximum tolerated dose (8-12 grams daily) has been reached glucocorticoid and mineralocorticoid replacement necessary to prevent adrenal insufficiency increased steroid doses may be needed at times of physiologic stress... 

The goals of treatment for adrenal insufficiency are to limit morbidity and mortality, return the patient to a normal functional state, and prevent episodes of acute adrenal insufficiency. 

Autoimmune polyglandular syndrome-Chron c autoimmune thyroiditis may occur in association with other autoimmune disorders. Treat patients with concomitant adrenal insufficiency with replacement glucocorticoids prior to initiation of treatment. Failure to do so may precipitate an acute adrenal crisis when thyroid hormone therapy is initiated. Patients with diabetes mellitus may require upward adjustments of their antidiabetic therapeutic regimens. Nontoxic diffuse goiter or nodular thyroid disease Use caution when administering levothyroxine to patients with nontoxic diffuse goiter or nodular thyroid disease in order to prevent precipitation of thyrotoxicosis. If the serum TSH is already suppressed, do not administer levothyroxine. 

Giving exogenous corticosteroids suppresses ACTH secretion which results in adrenal gland atrophy. Therefore glucocorticosteroid doses should be tapered off to allow the patient to adjust and prevent symptoms of adrenal insufficiency. For the short acting glucocorticosteroids an alternate day regimen should be considered to lower the risks for adrenal suppression. 

In patients with longstanding hypothyroidism and those with ischemic heart disease, rapid correction of hypothyroidism may precipitate angina, cardiac arrhythmias, or other adverse effects. For these patients, replacement therapy should be started at low initial doses, followed by slow titration to full replacement as tolerated over several months. If hypothyroidism and some degree of adrenal insufficiency coexist, an appropriate adjustment of the corticosteroid replacement must be initiated prior to thyroid hormone replacement therapy. This prevents acute adrenocortical insufficiency that could otherwise arise from a thyroid hormone-induced increase in the metabolic clearance rate of adrenocortical hormones. 

Systemic corticosteroid effects from inhaled and nasal steroids inadequate to prevent adrenal insufficiency in patients withdrawn from corticosteroids abruptly... 

Mechl orethamine 0.4 mg/kg IV in single or divided doses Nausea and vomiting, myelosuppression Moderate depression of peripheral blood count excessive doses produce severe bone marrow depression with leukopenia, thrombocytopenia, and bleeding alopecia and hemorrhagic cystitis occasionally occur with cyclophosphamide cystitis can be prevented with adequate hydration busulfan is associated with skin pigmentation, pulmonary fibrosis, and adrenal insufficiency... 

In addition to the attempts described below to interfere with the onset or progression of neurological disease, it is also important to carry out endocrine testing on all biochemically identified males to assess their adrenocortical axis. In particular, all patients who have adrenal insufficiency require adrenal hormone replacement to prevent life-threatening complications of insufficiency. 

Destruction of the pituitary gland may result in secondary hypothyroidism, hypogonadism, adrenal insufficiency, growth hormone deficiency, and hypoprolactinemia. The formation of certain types of pituitary tumors may result in pituitary hormone excess. Pituitary tumors may also physically compress the pituitary and prevent the release of the trophic hypothalamic factors that regulate pituitary hormones. In this chapter, the pathophysiology and role of pharmacotherapy in the treatment of acromegaly, short stature, hyperprolactinemia, and panhypopituitarism will be discussed. 

Steroids must be tapered to prevent adrenal insufficiency. The dose pack is prescribed to ensure that the client takes the correct amount of medication daily. 

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