Instructions for Patients with Adrenal Insufficiency

You have been diagnosed with a condition called "Adrenal Insufficiency." This can be caused by a disorder of your pituitary or adrenal gland. Adrenal insufficiency is a life threatening chronic illness. As with most chronic diseases, adrenal insufficiency demands that the patient take responsibility and develop self-management skills and techniques. The following guidelines should help you in this endeavor.

Obtain and always wear a medical alert bracelet or tag. Also carry an emergency identification card that identifies your underlying diagnosis and the fact that you have adrenal insufficiency.

Maintenance therapy
In most instances, maintenance therapy will include a glucocorticoid hormone, prednisone, hydrocortisone (Cortef), or dexamethasone (Decadron). Some individuals also require a mineralocorticoid hormone, fludrocortisone (Florinef). Take your prescribed doses of these medications every day.

Minor illnesses
For people whose pituitary and adrenal glands are functioning normally, minor illnesses and stresses promote an increased adrenal output of cortisol. Patients with adrenal insufficiency cannot muster this response. Therefore, if you have adrenal insufficiency, be aware that you will need increased doses of your glucocorticoid medication. 

If you are sick with any of the following:

  • Fever > 100 degrees
  • Gastrointestinal illness: Vomiting or moderate to severe diarrhea
  • Infection (for example: flu, pneumonia, urinary tract infection, or any illness for which you take antibiotics)
  • Other significant illness or injury (page your endocrine doctor to determine if necessary)

When you are sick:

  • Increase your daily dose to prednisone 10 mg a day, hydrocortisone 20 mg twice a day (every 12 hours), or dexamethasone 1 mg a day
  • Continue that increased dose until you no longer have a fever and your symptoms have improved (contact your doctore if you are not better within 1 week)
  • When you are better, return to your regular daily dose

If you vomit within 2 hours after taking the steroid medication:

  • Take your dose again
  • If you vomit again within 2 hours
    • You will need to go to your doctor's office or a local Emergency Room to receive an injections of steroid medication.
    • Page your endocrine doctor

These are basic guidelines. If you have any questions about what medication dose to take, call your endocrine doctor.

Obtain a Medic Alert bracelet or necklace and and wallet card that is engraved with "Adrenal Insufficiency"  MedicAlert 888-633-4298    2323 Colorado Avenue Turlock, CA 95382  www.medicalert.org

If you will be traveling in a remote area, it may be appropriate for you to carry a "Steroid Emergency Kit" with you - contact your endocrine doctor for details about how to obtian the kit and how to administer the medication.

If you are hospitalized
If you have to be hospitalized for any treatment, make sure that your physician is aware that adjustments in glucocorticoid doses are necessary for even moderately stressful procedures such as:

  • barium enemas
  • endoscopy
  • arteriography, and
  • certain surgical procedures.

Supplementing with additional hydrocortisone is typically not required for outpatient dental procedures that are performed under local anesthesia, minor surgical procedures done under local anesthesia, and most noninvasive radiological studies.

If you will be having surgery, contact your endocrine doctor prior to your procedure for medication instructions.