Oral glucocorticoids for hyperplasia
Removal of tumors
Glucocorticoids are used for adrenal hyperplasia, typically oral hydrocortisone 10 mg on arising, 5 mg at midday and 5 mg in the late afternoon. Alternatively, dexamethasone 0.5 to 1 mg po may be given at bedtime, but even these small doses may cause signs of Cushing syndrome. Giving the dose at bedtime is most appropriate in terms of suppressing ACTH secretion but may cause insomnia. Cortisol 25 mg po once/day or prednisone 5 to 10 mg po once/day can be used instead. Although most symptoms and signs of virilism disappear, hirsutism and baldness disappear slowly, the voice may remain deep, and fertility may be impaired.
Tumors require adrenalectomy. For patients with cortisol -secreting tumors, hydrocortisone should be given preoperatively and postoperatively because their nontumorous adrenal cortex will be atrophic and suppressed.