For chronic adrenocortical failure, maintenance therapy with hydrocortisone is initiated, usually together with 9a-fludrocortisone to replace the mineralocorticoid deficiency.
Mineralocorticoid replacement with 9a-fludrocortisone is given either daily or on alternate days; the dose varies from 0.05mg on alternate days, to 0.2mg daily. If the dose is excessive, oedema and hypertension may result.
Adequacy of mineralocorticoid replacement can be monitored by measurement of plasma renin activity. Elevated plasma renin activity usually signifies that inadequate mineralocorticoid replacement has been given. In practice, twice-daily 9a-fludrocortisone may provide better suppression of renin than once-daily therapy.
