Steroid dose equivalents

From Dr. Lewis Blevins.  There is a lot of confusion as to what constitutes a replacement dose of a steroid hormone for patients with hypopituitarism. The textbooks are wrong and, if we took doses they suggest, we’d all have Cushingoid bodies with attendant problems. The following suggested doses are based on plenty of papers studying the topic and my clinical experience. So, if you take steroids to replace pituitary-adrenal function….these doses can be a guide …bearing in mind some people need more or less depending on their size, whether they are slow metabolizers of steroids, or take GH, are pregnant, etc.

Dexamethasone 0.25 to 0.375 mg daily
Prednisone 3-4 mg daily
Hydrocortisone 10-20 mg daily in divided doses
Cortisone acetate 25 mg daily in divided doses

We will need to see how the new proposed long release steroids fare in regards to effective doses.

There really is no point in doing blood tests to asses treatment. It’s a clinical decision between the patient and the doctor. The goal is to treat so there are no symptoms of adrenal insufficiency and no side-effects of steroids. Steroids are double-edged swords so to speak….one edge helps you and saves your life while the other can kill you. Be careful to avoid over-replacement.

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