Wednesday October 17, 2007



Q; What is the physiologic amount of cortisol secreted by adrenals per day?



A; Adults secrete about 20 mg of cortisol daily.

We use anywhere from 200 - 300 mg of hydrocortisone as stress dose to encounter adrenal insufficiency. In USA, we prescribe it in divided doses and our european counterpart use it in a continuous drip and mostly along with fludrocortisone. But it may be of interest to know that physiologically, adrenal cortex in adults secrete only 20 mg of cortisol daily. It also secretes 2 mg of corticosterone which has similar activity. We use higher dose under presumption that due to stress body may require higher cortisol level. Usually, if its pure adrenal insufficiancy, restoration of BP and general improvement may be seen within 1 hour after the initial dose of hydrocortisone.

Some experts advise to leave the dose at 20 mg per day of hydrocortisone once hemodynamics are improved and stress is resolved and taper it later 1.


Related previous pearl:

Hypoproteinemia and cosyntropin test

Low dose steroid, yes or no ? - responder or non-responder ? - low-dose corticotropin stimulation test or high dose?

Hydrocortisone and Dexamethasone


Relevant study to know:

Corticus study (Corticosteroid Therapy of Septic Shock).


Reference:

1. The ICU Book : Paul L. Marino : 2nd edition: Page 770