Secondary Insufficiency

Treatment of secondary adrenal insufficiency differs from that of primary adrenal insufficiency with regard to mineralocorticoid and androgen replacement. Patients with secondary adrenal failure usually do not require mineralocorticoid therapy and can maintain salt and fluid balance with a diet generous in sodium chloride. In the presence of hypotension, however, supplementary fludrocortisone acetate, 0.05 to 0.1 mg/day, is indicated. Evidence of androgen insufficiency may occur with male and female patients with hypopituitarism. Sufficient androgen in the female patient can be achieved with 2 to 5 mg of fluoxymesterone orally per day. Larger dosages of this preparation or long-acting testosterone (Depo-Testosterone) can be used in the male patient. Patients with secondary insufficiency will also require thyroid hormone replacement.

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