Patients with Addison’s disease and/ or panhypopituitarism require glucocorticoid replacement (usually with oral hydrocortisone) and mineralocorticoid replacement (usually with fludrocortisone).
It is important that patients increase their dose of glucocorticoid if they are under physical stress, such as during a period of illness or strenuous exercise, to reduce the risk of adrenal crisis. The Endocrinologists provide patients with ‘sick day rules’ guiding them about how to manage their steroid dosing when unwell. This includes when to seek medical attention, and when to self-administer intramuscular hydrocortisone.
CKS guidance about corticosteroid dosing in intercurrent illness is provided here.
Please note that if a patient has vomited, they should use their emergency hydrocortisone injection and seek immediate medical attention. Have a low threshold for referring the patient directly to secondary care. If adrenal crisis is suspected, emergency hospital admission is required.