BSPED Adrenal Insufficiency Consensus Guidelines

BSPED Adrenal Insufficiency Consensus Guidelines

This means they’ll be able to make sure you get any treatment you need appropriately and quickly. 88% answered they will give steroids intravenously if patients present with gastrointestinal illness and 94% answered they will give steroids intravenously if patients are nil by mouth. When asked about information which should be given to patients who are taking long steroids, only 50% answered correctly.

  • If your child has severe diarrhoea and is also being sick, you should give them a hydorcortisone injection into their thigh and call an ambulance to go to hospital immediately.
  • Parents and carers can input doses, contact numbers and what to do when an A&E doctor takes over the care of your child.
  • This helps you cope with the stressful situation and additional strain on your body that results from serious injury.
  • Signs of crisis can include severe dizziness with serious vomiting and/or diarrhoea.

People having an adrenal crisis may have sudden confusion, tiredness, headache, extreme weakness,chills or fever. To empower our steroid-dependent patients to manage their medications independently, allowing patients to remain in control of their health and well-being. • You have a temperature of 38.0 degrees or above.• You get a bad cold, flu, diarrhoea or other infection that makes you feel poorly or weak.• You break a bone or suffer from any similar significant injury. If you’re feeling off-colour, injured or ill, follow these rules to keep safe and reduce the chances of an adrenal crisis.

Steroid replacement for adrenal insufficiency

Challenging physical exercise such as competitive sport, may need extra medication. You may need to double your normal dose during the competition. 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. In cases of vomiting or shock, people with adrenal insufficiency can experience a sudden drop in blood pressure.

  • All patients requiring a dose of IM or IV hydrocortisone must be observed for at least 6 hours and have kept down at least one oral sick day dose prior to discharge.
  • If you’re receiving treatment for Addison’s disease, you’re entitled to a medical exemption certificate.
  • The information provided in this resource will guide you as to how to manage steroid replacement.
  • If they are unwell or develop a temperature after their immunisation, then treble their dose of steroid until they improve.

At times of physiological stress such as illness, trauma or surgery there is an increased requirement for exogenous glucocorticoids, which if untreated can lead to an adrenal crisis and death. Normally, people produce more cortisol than usual in response to illness, injury and surgery. It is very important that children and young people receiving steroid replacement therapy increase their normal dose of steroids to copy this response.

Society for Endocrinology BES 2013

Information is vital for pituitary patients and we can’t do this without you. If you are on any other form of long-term steroid, please get in touch with your doctor for further information. This will give you a guide if you need to drink more fluids. You can find advice on preparing for hospital admission here so you can get everything ready.

Sick Day Rules

However, always consult your GP or specialist if you’re unsure. You could also tell close friends or colleagues about your condition. Tell them about the signs of adrenal crisis and what they should do if you have one. Many people with Addison’s disease find that taking their medicine enables them to continue with their normal diet and exercise routines.

Patient Information

Fortunately, cortisol can be replaced easily with daily steroid tablets. These steroid tablets are essential for your health and must never be stopped suddenly. It’s important that you gradually taper any increased dose hydrocortisone down to your usual hydrocortisone dose. To keep you stable, don’t suddenly go back to your normal dose.

What are the adrenal glands?

Your GP or endocrinology team can prescribe the medicine needed for an emergency hydrocortisone injection kit. The ADSHG advises you always to have 3 months’ supply available of your essential steroid medicine. This is in case you need to increase your dose to follow your sick day rules, or to cover if there is a shortage of your medicine.

Step 2: Draw up the hydrocortisone

In hospital, you’ll be given lots of fluid through a vein in your arm to rehydrate you. This will contain a mixture of salts and sugars (sodium, glucose and dextrose) to replace what your body is lacking. You’ll also be injected with hydrocortisone to replace the missing cortisol hormone.

This could be necessary if you go into shock after an injury, or if you experience vomiting or diarrhoea and are unable to keep down oral medicine. This may happen if you’re pregnant and have morning sickness. Your endocrinologist will discuss with you when an injection might be necessary. You and a partner or those you live with should be trained to inject hydrocortisone in an emergency.


Missing doses of steroids for patients with adrenal insufficiency can lead to adrenal crisis; a medical emergency which if left untreated can be fatal. Patients with adrenal insufficiency require higher doses of steroids if they become acutely ill or are subject to major body stressors, such as from trauma or surgery, to prevent an adrenal crisis. This is when you increase your medicine dose to keep you well during periods of stress, illness or injury. If you do not increase your dose at these times, you may experience an adrenal crisis.

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