Rationalising oral corticosteroids used for adrenal insufficiency

Follow the principles of medication rationalisation when rationalising corticosteroids in palliative care.

In general, continue corticosteroid replacement for primary and secondary adrenal insufficiencies (eg Addison disease, insufficiency due to a pituitary disorder) until death. If corticosteroids are stopped, features of adrenal insufficiency, which can be difficult to distinguish from disease progression, can re-emerge or an adrenal crisis could occur. Make a plan for when the patient cannot swallow, preferably in consultation with the patient’s endocrinologist. In the last days of life, a physiological replacement dose of subcutaneous dexamethasone (1 mg) may be sufficient for some patients—seek specialist palliative care advice if necessary.