Managing adrenal insufficiency and steroid replacement Sheffield Children’s NHS Foundation Trust

Managing adrenal insufficiency and steroid replacement Sheffield Children’s NHS Foundation Trust

It’s important that you gradually taper any increased dose hydrocortisone down to your usual hydrocortisone dose. Sometimes, the underlying causes of Addison’s disease can be treated. For example, tuberculosis (TB) is treated with a course of antibiotics over a period of at least six months.

  • Adrenal insufficiency is a condition in which the adrenal glands (small hormone producing glands sitting above the kidneys) stop producing enough cortisol.
  • If your child has a minor injury such as a bump, cut or graze and they can recover straight away and resume activities, then you do not need to increase their dose of hydrocortisone.
  • When your child is unwell, giving these medications together may mean their sodium level drops.
  • While this works well for treating coronavirus, the side effects can affect blood sugar management.

Challenging physical exercise such as competitive sport, may need extra medication. For any sports with a risk of physical injury, you must ensure that a teammate has been trained to administer an emergency injection if needed. You’ll need to know how to manage insulin or other diabetes medications, blood or urine tests, and your diet, and how to manage your diabetes when you’re sick. This is really important if you go into hospital or if you need to take steroids as part of your treatment.

What is adrenal insufficiency?

At the time of publishing this article, patients requiring steroid replacement for life are not among the highest risk group identified by the UK government. Nonetheless, they lack part of physiological response to stress and are probably more vulnerable in general to illness or any infection, including coronavirus. Gentle exercise such as recreational swimming or walking does not usually need extra medication.

It can affect people of any age, although it’s most common between the ages of 30 and 50. Patient with a corticosteroid on repeat (and at least 3 issues in the last 12 months) will be flagged if they have not had BP, U+E, Hba1c (adults) and height (children). Guidance on Emergency Card and Sick Day Rules links to a page which shows the guidance. The ‘Strength’ links take the user to guidance about relative strengths of different steroid preparations which are needed to interpret the guidance (examples below).

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This is because the treatment is just replacing what the body should normally produce. Your doctor will advise on your correct doses and also when or if, to reduce the doses. Some people with coronavirus are being treated with a type of steroid called dexamethasone.


Most people with the condition live a normal lifespan and are able to live an active life, with few limitations. In case you are taking steroid replacement for life, here is a reminder of sick day rules. The NHS Steroid Emergency Card was launched in August 2020 to improve patient safety for those with adrenal insufficiency.

Living with Addison’s disease

But IF YOU ARE UNWELL WITH A FEVER, INCREASE YOUR ORAL STEROID DOSE until you are completely better. Whether you’re newly diagnosed or have lived with the condition for years – please join our community and support our cause! You’ll receive the latest expert advice, guidance and ADSHG news, whilst being part of our inspiring and supportive community. We’ve published ADSHG’s general COVID-19 guidance and this tells you everything you need to know.

Protecting yourself against illness

Although these symptoms aren’t always caused by Addison’s disease, you should see your GP if you have them so they can be investigated. Once the patient has been provided with the relevant information, click the Patient Has/Given SEC/SDRs buttons as appropriate. A patient specific SEC can be created within S1 using the Create Steroid Emergency Card button.

Sick Day Medication Rules

As your body cannot produce cortisol, you’ll need a hydrocortisone injection to replace it and prevent an adrenal crisis. People with Addison’s disease often have an underactive thyroid gland (hypothyroidism), where the thyroid gland does not produce enough hormones. By testing the levels of certain hormones in your blood, your endocrinologist (a specialist in hormone conditions) can determine whether you have hypothyroidism. People with Addison’s disease must be aware of the risk of a sudden worsening of symptoms, called an adrenal crisis.

Treating Addison’s disease

This should help you to live an active life, although many people find they still need to manage their fatigue. Tuberculosis (TB) is the most common cause of Addison’s disease worldwide, but is rare in the UK. TB is a bacterial infection that mostly affects the lungs, but can also spread to other parts of your body. It can cause Addison’s disease if it damages your adrenal glands.

Wearing a medical alert bracelet will inform any medical staff treating you about your condition, and what medication you require. If the ACTH level is high, but the cortisol and aldosterone levels are low, it’s usually confirmation of Addison’s disease. A blood sample will be taken and tested for cortisol, before an injection of synacthen is given into your arm.