For chronic adrenocortical failure, maintenance therapy with hydrocortisone is initiated, usually together with 9a-fludrocortisone to replace the mineralocorticoid deficiency.
Most patients require 20mg oral hydrocortisone on waking and 10mg at 1800. Occasional patients feel better on hydrocortisone given three times daily rather than twice daily. Adequate replacement therapy should reverse the pigmentation but should not produce Cushing's syndrome. Plasma cortisol levels should be measured during the day on replacement therapy to determine if the correct dose has been given (Fig. 9.11).
