Intercurrent illness
At the onset of symptoms of illness (eg significant nausea or dizziness), the patient should increase their glucocorticoid dose promptly, regardless of the time of day and without waiting to consult a doctor. The higher dose should usually be continued for 2 to 3 days. If the illness has not resolved after 3 days, the patient should seek medical advice rather than continuing the high dose.
The patient may have an individualised ‘sick day’ action plan provided by their endocrinologist. Otherwise, for an adult whose usual maintenance therapy is hydrocortisone, a reasonable regimen is:
hydrocortisone 20 mg orally, 3 times daily, gradually reducing to maintenance dose over 2 to 3 days. adrenal insufficiency, intercurrent illness (adult) hydrocortisone
For an adult whose usual maintenance therapy is cortisone acetate, a reasonable regimen is:
cortisone acetate 25 mg orally, 3 times daily, gradually reducing to maintenance dose over 2 to 3 days. adrenal insufficiency, intercurrent illness (adult) cortisone acetate
For an adult whose usual maintenance therapy is prednisolone (or prednisone), a reasonable regimen is:
prednisolone (or prednisone) 15 mg orally, once daily, gradually reducing to maintenance dose over 2 to 3 days. adrenal insufficiency, intercurrent illness (adult) prednis ol one
For a child whose usual maintenance therapy is hydrocortisone, a reasonable regimen is:
hydrocortisone 10 mg/m2 orally, 6- to 8-hourly, gradually reducing to maintenance dose over 2 to 3 days1. adrenal insufficiency, intercurrent illness (child) hydrocortisone
For a child whose usual maintenance therapy is cortisone acetate, a reasonable regimen is:
cortisone acetate 12.5 mg/m2 orally, 6- to 8-hourly, gradually reducing to maintenance dose over 2 to 3 days1. adrenal insufficiency, intercurrent illness (child) cortisone acetate
If the patient has features of impending adrenal crisis (eg abdominal pain, dehydration, hypotension), medical attention and parenteral hydrocortisone are recommended. Parenteral therapy may also be required if the patient is vomiting. For an adult, use:
hydrocortisone 100 mg intramuscularly. adrenal insufficiency, impending adrenal crisis (adult) hydrocortisone
For a child, use:
hydrocortisone adrenal insufficiency, impending adrenal crisis (child) hydrocortisone
child younger than 3 years: 25 mg intramuscularly
child 3 to 12 years: 50 mg intramuscularly.
If a parenteral glucocorticoid is not available, an equivalent dose of oral therapy should be taken even if the patient is vomiting.
Major illnesses (eg haemodynamic instability) should be managed in hospital with hydrocortisone replacement as for adrenal crisis.