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Adrenal Insufficiency instructions for Stress Dosing

 What do you do when you’re not feeling well?  

  • Infections (fever greater than 100°F, sinusitis, UTI, flu etc.) 
  • Trauma (accidents, fractures etc.) 
  • Surgery 
  • Major dental procedures 
  • Endoscopies 

In a normal person, the adrenal gland produces more hydrocortisone when the body is under physical stress and as well as during severe emotionally stressful situations. If you have adrenal insufficiency, you are not able to do that. This can lead to a variety of symptoms (weakness, dizziness, loss of appetite, and low blood pressure).  If your body does not get extra hydrocortisone, you may get very sick, and the situation can potentially be lethal.  This is called an “adrenal crisis”. 

To prevent this from occurring, your physician will provide you recommendations to temporarily increase the dose of hydrocortisone do you help your body combat This stress. Usually, the dose of hydrocortisone (usually the hydrocortisone dose must be doubled or tripled, depending on the severity of the stressful situation).  Fludrocortisone dose does not require this kind of adjustment.   

If you are unable to eat or keep your medications down, you may need to take an emergency injection of hydrocortisone, or a related compound called dexamethasone. If you do not have access to the injectable steroid, you may need to go to the emergency room and get an intravenous dose of hydrocortisone as well as some intravenous fluids for dehydration which may ensue.  

As soon as your illness is over and the symptoms have resolved (e.g. resolution of fever, diarrhoea, vomiting), you can usually resume your normal dose of hydrocortisone.  The exact details of how to take these steps should be discussed with your physician because the directions may need to be modified depending on your unique clinical factors. 

Please note that the fludrocortisone typically does not need to be increased under the circumstances. However, if you are going to be in hot weather for a long time, you may be at risk of developing dehydration; therefore, you may need to temporarily increase the dose of fludrocortisone.  Once again, consult with your physician for recommendations that are specific to you. 

With your physician’s guidance, you can and you should develop a plan to address these adjustments (which are also called, stress dosing) before such conditions develop.  There is also important to understand that you should not continue an increased dose of hydrocortisone for an extended period of time without checking with your physician.  Too much hydrocortisone can lead to weight gain, type 2 diabetes, osteoporosis, or cardiovascular disease.  

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