{ "schema_version": 1, "kind": "condition", "id": "adrenal-insufficiency", "name": "Adrenal insufficiency (Addison's disease)", "category": "chronic", "sources": "Adrenal Insufficiency - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK441832/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class TD99.01 - condition scope only, no dose · Endocrine Society Guideline for Hormonal Replacement in Adrenal Insufficiency 2016 · Egyptian National Drug Formulary - Endocrine System 2024 (fludrocortisone monograph)", "review_status": "reviewed", "verified_against": "Adrenal insufficiency (Addison's disease) - disease-level clinical article (adrenal-insufficiency-clinical.txt) · Endocrine Society Guideline for Hormonal Replacement in Adrenal Insufficiency 2016 · Egyptian National Drug Formulary - Endocrine System 2024 (fludrocortisone monograph) · Adrenal Insufficiency - disease-level clinical article (adrenal-insufficiency-referral-clinical.txt)", "verified_date": "2026-08", "treatments": [ { "id": 107, "generic": "Hydrocortisone", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 10.0, "adult_dose": "15-25 mg daily in divided doses (e.g. 10 mg on waking, 5 mg at midday, 5 mg early afternoon to replicate physiological cortisol rhythm)", "adult_duration": "long-term lifelong", "dose_source": "Endocrine Society Guideline for Hormonal Replacement in Adrenal Insufficiency 2016", "rationale": "Physiological glucocorticoid replacement for adrenal insufficiency, timed across the day to mimic the body's own cortisol rhythm since the adrenal glands can no longer produce it; lifelong replacement rather than anti-inflammatory treatment.", "cautions": [ "MUST DOUBLE or TRIPLE dose during intercurrent illness, fever, or acute stress ('sick-day rules').", "Issue steroid emergency card and self-injectable hydrocortisone emergency kit.", "Avoid late evening doses to prevent insomnia.", "Egypt has no registered oral hydrocortisone. The only pack in the register is an unlicensed import at around 66 EGP, and it is shown because it is the only thing there - not because it is a reliable supply. In a disease where running out means an adrenal crisis, that is the single most important practical fact about this prescription.", "So plan the supply before it is needed: confirm the patient can actually obtain the next box, keep a margin in hand rather than filling at the last tablet, and agree in advance what they do if the pharmacy cannot get it. Whether to replace it with an equivalent dose of a registered steroid is a decision for the treating physician, and it should be made at a clinic visit, not in the middle of an illness." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "8-10 mg/m2/day in 3 divided doses under pediatric endocrinologist management", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "HYDROCORTISONE ROUSSEL 10MG 25 TABS.(ILLEGAL IMPORT)", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SANOFI >", "price_egp": 66.0, "pack_count": 25, "unit_price": 2.64, "strength_mg": 10.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "adrenal-insufficiency" }, { "id": 109, "generic": "Referral & safety-netting (no drug therapy)", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": "Addison's disease and secondary adrenal insufficiency occur and are life-threatening if missed; the GP recognises symptoms, may give an emergency steroid, and refers to endocrinology for long-term management.", "adult_duration": null, "dose_source": "Adrenal Insufficiency - disease-level clinical article (adrenal-insufficiency-referral-clinical.txt)", "rationale": "Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.", "cautions": [ "Adrenal crisis - low blood pressure, vomiting, collapse - is a medical emergency requiring immediate parenteral steroid and hospital transfer." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Children follow the same pathway: recognise and refer. Replacement steroid doses are started and titrated by a paediatric endocrinologist.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "adrenal-insufficiency" }, { "id": 110, "generic": "Prednisone", "line": 2, "is_adjunct": false, "form": "oral.solid", "strength_mg": null, "adult_dose": "Prednisone 5 mg (2.5 to 7.5 mg) orally at bedtime", "adult_duration": "long-term lifelong", "dose_source": "Adrenal Insufficiency (Addison's Disease - Maintenance) - disease-level clinical article (adrenal-insufficiency-referral-clinical.txt)", "rationale": "Alternative longer-acting oral glucocorticoid replacement for chronic primary adrenal insufficiency.", "cautions": [ "MUST DOUBLE or TRIPLE dose during intercurrent illness, fever, or acute stress ('sick-day rules').", "Issue steroid emergency card and self-injectable hydrocortisone emergency kit." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "The source gives no paediatric prednisone dose for maintenance replacement; its only prednisone maintenance dose is the adult one above. A child's replacement steroid is hydrocortisone 8-10 mg/m2/day in 3 divided doses, started and titrated by a paediatric endocrinologist.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "HOSTACORTIN 5MG 30 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SANOFI AVENTIS > SANOFI", "price_egp": 12.0, "pack_count": 30, "unit_price": 0.4, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "adrenal-insufficiency" }, { "id": 108, "generic": "Fludrocortisone", "line": 1, "is_adjunct": true, "form": "oral.solid", "strength_mg": 0.1, "adult_dose": "50-200 mcg (0.05-0.2 mg) once daily in the morning for mineralocorticoid replacement in primary adrenal insufficiency", "adult_duration": "long-term lifelong", "dose_source": "Egyptian National Drug Formulary - Endocrine System 2024 (fludrocortisone monograph)", "rationale": "Synthetic mineralocorticoid that replaces the aldosterone activity lost in primary adrenal insufficiency, helping maintain sodium and potassium balance; added to glucocorticoid replacement rather than used alone, and needed only when the adrenal failure is primary.", "cautions": [ "Required in primary adrenal insufficiency (Addison's); not required in secondary adrenal failure.", "Monitor blood pressure, serum potassium, and plasma renin activity." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "50-150 mcg daily under pediatric endocrinologist care", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "ASTONIN-H 0.1MG 30 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AMOUN > MERCK KGAA F.R.GERMANY", "price_egp": 18.0, "pack_count": 30, "unit_price": 0.6, "strength_mg": 0.1, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CORTILON 0.1 MG 20 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AMOUN", "price_egp": 16.0, "pack_count": 20, "unit_price": 0.8, "strength_mg": 0.1, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "adrenal-insufficiency" } ] }