Overview of glucocorticoid replacement during intercurrent illness and surgery

During a significant systemic illness or surgery, patients with adrenal insufficiency require an increased glucocorticoid dose. This applies to patients with glucocorticoid deficiency resulting from a primary adrenal disorder, hypopituitarism, adrenocortical suppression or congenital adrenal hyperplasia. The increased dose simulates the normal increase in cortisol secretion that occurs in response to stress, and is crucial to prevent acute cortisol deficiency and adrenal crisis.

Ensure patients are well educated about the importance of adjusting glucocorticoid doses in response to illness; see Patient education. The Royal Children’s Hospital website provides information for patients and carers about dosing of glucocorticoids during illness to prevent adrenal crisis.