Which treatment is considered the choice for primary adrenal insufficiency?

For primary adrenal insufficiency, the treatment of choice is hydrocortisone. This condition, often referred to as Addison's disease, involves the inadequate production of glucocorticoids, primarily cortisol, due to adrenal gland dysfunction. Hydrocortisone, a synthetic form of cortisol, effectively replaces this deficiency and helps manage the various symptoms associated with the condition, such as fatigue, weight loss, and hypotension.

Hydrocortisone mimics the diurnal patterns of cortisol secretion in healthy individuals, providing both immediate and long-term relief of symptoms. Its pharmacological actions, including anti-inflammatory and immunosuppressive effects, are similar to those of natural cortisol.

While fludrocortisone, which is a mineralocorticoid, plays a crucial role in managing adrenal insufficiency by addressing the need for aldosterone secretion that regulates sodium and potassium balance, it is not the primary choice for treating the overall cortisol deficiency characteristic of primary adrenal insufficiency. Hence, hydrocortisone remains the cornerstone of therapy.

Androgen replacement is not routinely necessary for primary adrenal insufficiency unless there are specific deficiencies or symptoms associated with adrenal androgen levels. Oral prednisone, although effective for various conditions involving corticoid deficiency, is not the first-line