Monitoring

Patients should be evaluated annually to judge adequacy of glucocorticoid and mineralocorticoid replacement.[2] Annual laboratory examination should include serum electrolytes measurement to monitor mineralocorticoid replacement.

Glucocorticoid adjustments are made according to signs and symptoms. Continuance of excessive fatigue and increasing pigmentation after start of treatment are suggestive of insufficient glucocorticoid replacement. Conversely, weight gain or facial plethora suggests glucocorticoid excess.

Mineralocorticoid replacement should be tapered down if the patient presents with fluid retention, hypertension, decreased renin activity, or hypokalaemia, and increased if there is postural hypotension or hyperkalaemia.

Long-term over-replacement of glucocorticoid may be associated with decreased bone density. Regular measurements of bone mineral density are suggested.[3]

In patients with autoimmune adrenalitis, surveillance for other associated autoimmune diseases is suggested.[2][4][35] Commonly associated conditions include autoimmune thyroid disease, autoimmune gastritis, type 1 diabetes, premature ovarian failure, vitiligo, or coeliac disease.[9]

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