# Enda Avoid Dexamethasone Pai

> Recommends against dexamethasone for glucocorticoid replacement in primary adrenal insufficiency (PAI) due to risk of Cushingoid side effects from difficult dose titration. Use when selecting a glucocorticoid for PAI management to avoid iatrogenic Cushing syndrome.

- Skill: `dromlakhani/enda-avoid-dexamethasone-pai` (Agent Skill)
- Install (CLI): `npx skillmds@latest add dromlakhani/enda-avoid-dexamethasone-pai`
- Raw SKILL.md: https://api.skillmd.com/api/skills/dromlakhani/enda-avoid-dexamethasone-pai/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: 2026-09-08
- Page: https://skillmd.com/skills/dromlakhani/enda-avoid-dexamethasone-pai

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# Avoid Dexamethasone for PAI Treatment Due to Cushingoid Side Effects

## STEP 1 — Gather Information
Confirm diagnosis of primary adrenal insufficiency (PAI) and assess need for glucocorticoid replacement therapy.

## STEP 2 — Rule In / Rule Out
Is dexamethasone being considered for glucocorticoid replacement in PAI? If yes, proceed to avoid; if no, continue with standard glucocorticoid selection.

## STEP 3 — Classify or Stratify
Classify glucocorticoid options into preferred (hydrocortisone, cortisone acetate, prednisolone) and non-preferred (dexamethasone) for PAI based on Cushingoid risk and titration difficulty.

## STEP 4 — Decide
Select a preferred glucocorticoid (hydrocortisone 15–25 mg/day or cortisone acetate 20–35 mg/day in divided doses) and avoid dexamethasone for PAI treatment.

## Clinical Guardrails / Mimics / Pitfalls
Do not use dexamethasone for PAI due to its long half-life and lack of mineralocorticoid activity, which complicates dose titration and increases Cushingoid risk; avoid in pediatric patients; monitor for weight gain, hyperglycemia, hypertension if inadvertently used; do not rely on dexamethasone for emergency dosing.

## Concrete Clinical Example
A 50-year-old woman with confirmed PAI is being evaluated for glucocorticoid replacement; the clinician considers dexamethasone for once-daily convenience but chooses hydrocortisone 20 mg daily in two divided doses after reviewing guideline 3.4 to prevent Cushingoid complications.

**Source:** Diagnosis and Treatment of Primary Adrenal Insufficiency: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2016, DOI:10.1210/jc.2015-1710