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The Curbsiders Internal Medicine Podcast
#411 Adrenal Insufficiency with Dr. Atil Kargi
Oct 9, 2023
Dr. Atil Kargi, an expert in adrenal insufficiency, discusses diagnosing, managing, and treating adrenal insufficiency with a focus on interpretation of stimulation tests, distinguishing primary from secondary adrenal insufficiency, and educating patients about preventing adrenal crises. They also explore diagnostic testing options, medication adjustments, and the importance of involving an endocrinologist in the process.
01:28:47
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Quick takeaways
- Treating primary adrenal insufficiency requires glucocorticoid and mineralocorticoid replacement based on individual needs.
- Regular monitoring of cortisol levels is crucial to guide treatment and prevent adrenal crises.
Deep dives
Initial Dosing of Glucocorticoid Replacement
Treating a patient with primary adrenal insufficiency requires glucocorticoid replacement, usually with hydrocortisone. The dosing of hydrocortisone varies depending on the patient's age, weight, and individual needs. In general, it is recommended to start with a dose of 15-25 mg of hydrocortisone in divided doses throughout the day, with higher doses in the morning to mimic the natural cortisol secretion pattern. The dosage may need to be adjusted based on the patient's response and any signs of over or under replacement.
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