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Steroid Replacement for Adrenal Insufficiency

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STEROID REPLACEMENT FOR ADRENAL INSUFFICIENCY PATIENT INFORMATION LEAFLET This information leaflet is intended to provide support with the management of steroid replacement for people taking prednisolone or hydrocortisone due to adrenal insufficiency What Is Adrenal Insufficiency Adrenal insufficiency is a condition in which the adrenal glands small hormone producing glands sitting above the kidneys stop producing enough cortisol Cortisol is a naturally occurring steroid hormone which regulates blood pressure blood sugar and muscle strength It is a hormone that is essential for health severe deficiency can cause illness or even death The amount of cortisol produced by the adrenal glands is regulated by a hormone called adrenocorticotropic hormone ACTH which is produced by the pituitary gland a small gland producing many hormones which sits under the brain The adrenal glands also produce another hormone called mineralocorticoid The production of mineralocorticoid is not regulated by ACTH Adrenal insufficiency can occur due to many reasons including Primary adrenal failure this can be due to an autoimmune condition Addison s Disease or surgery to remove the adrenals or other adrenal conditions In this condition the adrenal glands do not make enough cortisol or mineralocorticoid Hypopituitarism This occurs when the pituitary gland does not produce enough of the hormone ACTH in turn resulting in too little cortisol being produced by the adrenal glands The adrenal glands produce enough mineralocorticoid in this condition Hypothalamic Pituitary Adrenal Axis Suppression HPA axis suppression Long term use of steroid medication such as prednisolone or dexamethasone can lead to suppression of the body s natural ACTH production causing the adrenal glands to stop producing enough cortisol There is sufficient production of mineralocorticoid in this condition It is possible for the ACTH production from the pituitary to recover over time How Is Adrenal Insufficiency Treated Fortunately cortisol can be replaced easily with daily steroid tablets These steroid tablets are essential for your health and must never be stopped suddenly Your doctor will advise on your correct doses and also when or if to reduce the doses Steroid medication is called prednisolone or hydrocortisone Prednisolone This is a long acting steroid medication which is usually taken once a day in the morning on waking but occasionally a second dose will be required during the day Hydrocortisone This is a short acting steroid medication It is usually given in two or three daily doses with the first dose always on waking It is the medicine of choice used when attempting to wean down steroid replacement if adrenal recovery is anticipated in HPA axis suppression However this should never be attempted without discussion with your endocrine doctor

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Fludrocortisone Patients may also require a medication called fludrocortisone to replace other hormones mineralocorticoids the adrenals glands make This medication is taken once daily in the morning Will I Be On Steroid Tablets Forever In some causes of adrenal insufficiency it may be possible to slowly reduce steroid doses over time in order to allow the pituitary and adrenal glands to recover This may eventually allow your doctor to stop your steroid medication Please note that it is very important only to reduce your steroid doses if your doctor has specifically advised you to What Do I Need To Know About Managing My Medications Take your steroid tablets prednisolone or hydrocortisone every day at the right time of day They are essential You can take your steroid tablets on an empty stomach unless you have pre existing digestive problems Always carry spare medication with you Order your repeat prescription in plenty of time ideally maintaining a month s reserve supply to ensure you do not run out of your essential medication Take an extra supply of medication i e double what you need with you on holiday plus your steroid injection kit if you have one Carry your medication and a steroid injection kit if you have one in your hand luggage when travelling by plane along with a doctor s note explaining why you need to carry medication What Could Go Wrong If I Don t Take Enough Medication In cases of vomiting or shock people with adrenal insufficiency can experience a sudden drop in blood pressure If you do not take sufficient extra medication you may experience an adrenal crisis which is a medical emergency An adrenal crisis is a state of sudden and severe low levels of cortisol It is a medical emergency Warning signs include severe nausea headache dizziness extreme weakness chills or fever confusion If you feel severely unwell take extra steroid medication immediately and call a doctor An emergency injection followed by urgent hospital treatment is needed for an adrenal crisis We recommend that you wear a medical alert identifier of some kind to alert emergency services to your condition If your job involves the risk of physical injury e g fire service military you will need to advise your employers of the risks of adrenal crisis and ensure that your colleagues are trained to administer an emergency injection if needed

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Are There Any Special Precautions I Will Need To Take Cortisol hormone is essential for life Ordinarily if we are sick or injured our bodies immediately produce more cortisol to cope with this stress Since your adrenal glands cannot do this reliably you will need to take extra steroid medication The general guidelines for extra steroid cover are Double your normal daily dose for minor illness or with a fever of more than 37 5 C If you need to double the dose for more than seven days you should consult your doctor Once you feel better you can gradually decrease the prednisolone or hydrocortisone back to your normal dose over a couple of days Vomiting illness Take a double dose immediately after you vomit and sip water to keep hydrated If you vomit twice and cannot keep medication down use your emergency injection kit if you have one then attend the Accident and Emergency Department Serious injury Take an extra dose of steroid medication orally immediately to avoid shock For minor procedures requiring local anaesthetic such as dental treatment take an extra dose one hour before the procedure For any other surgery Ensure your surgical team is aware of your need for extra medication and that they have checked the surgical guidelines for the correct level of steroid cover If in doubt please ask your doctor for a letter for your surgeon advising on the correct steroid dosages for you around the time of surgery What About Sport And Exercise Gentle exercise such as recreational swimming or walking does not usually need extra medication 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 Where Can I Get Further Information Information and support are available from the Addison s Disease Self Help Group ADSHG a registered charity run by and for people with Addison s disease which is also a good resource for people with adrenal insufficiency Contact www addisonsdisease org uk addisons ireland General endocrine information www yourhormones info

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Beacon Hospital Sandyford Dublin 18 D18 AK68 Tel 01 293 6600 www beaconhospital ie Version 26 8 2022

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