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 later1.
Relevant study to know:
Corticus study (Corticosteroid Therapy of Septic Shock). ซึ่งยังมี results ออกมาเรื่อยๆคงต้องตามดูกันต่อไปนะคะ
