Recommends hydrocortisone replacement dosing of 15–20 mg total daily, administered as a single dose or divided doses with the highest dose given in the morning upon awakening and the second dose in the afternoon (two-dose regimen) or second and third doses at lunch and late afternoon (three-dose regimen). Use when initiating glucocorticoid replacement for adrenal insufficiency; triggers include diagnosing adrenal insufficiency requiring glucocorticoid replacement.
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---
name: ata-hc-dosing-regimen
description: Recommends hydrocortisone replacement dosing of 15–20 mg total daily, administered as a single dose or divided doses with the highest dose given in the morning upon awakening and the second dose in the afternoon (two-dose regimen) or second and third doses at lunch and late afternoon (three-dose regimen). Use when initiating glucocorticoid replacement for adrenal insufficiency; triggers include diagnosing adrenal insufficiency requiring glucocorticoid replacement.
---
# Determine hydrocortisone replacement dosing regimen
## STEP 1 — Gather Information
Confirm diagnosis of adrenal insufficiency requiring glucocorticoid replacement; assess patient preference for dosing frequency; consider any contraindications to divided dosing (e.g., adherence issues, schedule constraints).
## STEP 2 — Rule In / Rule Out
Determine if the patient can adhere to divided dosing (two or three times daily) versus prefers a single daily dose regimen.
## STEP 3 — Classify or Stratify
If divided dosing is preferred, choose between a two-dose regimen (morning + afternoon) or three-dose regimen (morning + lunch + late afternoon) based on lifestyle; if single dose is preferred, prepare to administer the total daily dose once daily.
## STEP 4 — Decide
Prescribe hydrocortisone 15–20 mg total daily according to the selected regimen; provide clear instructions on timing and stress-dose adjustments for illness or surgery.
## Clinical Guardrails / Mimics / Pitfalls
Avoid over-replacement (>20 mg/day) unless clinically indicated for stress; avoid under-replacement (<15 mg/day) unless adverse effects occur; do not use fludrocortisone in secondary adrenal insufficiency; avoid dexamethasone for routine replacement; monitor for Cushingoid features, weight gain, or signs of adrenal crisis.
## Concrete Clinical Example
A 48-year-old man with new-onset secondary adrenal insufficiency prefers twice-daily dosing; prescribe HC 10 mg upon awakening and 5 mg in the afternoon; counsel on stress dosing (double or triple dose) during febrile illness.
**Source:** Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2016, doi:10.1210/jc.2016-2118
