Replacement hydrocortisone can be administered twice daily in doses of 20mg on waking and 10mg in the early evening in patients who need replacement for ACTH deficiency. The levels of cortisol obtained should be monitored by assessing a profile of serum cortisol in multiple samples that are obtained via an indwelling needle throughout the day, since the needs of individual patients vary from 15 to 60mg daily. Oral therapy should be increased during a febrile illness and, with vomiting or surgery, hydrocortisone should be given parenterally. In such situations it is prudent to issue a steroid card and instruct patients to wear a MedicAlert (or equivalent) bracelet. Mineralocorticoid replacement is unnecessary since aldosterone secretion is not ACTH dependent.
