# Ata Hc Dosing Regimen

> 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.

- Skill: `dromlakhani/ata-hc-dosing-regimen` (Agent Skill)
- Install (CLI): `npx skillmds add dromlakhani/ata-hc-dosing-regimen`
- Raw SKILL.md: https://api.skillmd.com/api/skills/dromlakhani/ata-hc-dosing-regimen/raw
- Safety review: pending (external: skill-scanner PASS, skillspector PASS)
- Works with: Claude Code, Claude.ai, OpenAI Codex
- Category: Coding & Dev Tools
- Author: dromlakhani (https://skillmd.com/u/dromlakhani)
- Updated: 2026-08-19
- Page: https://skillmd.com/skills/dromlakhani/ata-hc-dosing-regimen

---


# 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