Adrenal insufficiency is a rare condition where small glands above your kidneys (adrenal glands) do not work properly.

Steroid treatment advice

Steroids are used in several inflammatory conditions. Common types of steroid tablets are prednisolone, dexamethasone and hydrocortisone.

The following advice is for those on:

• 10mg or less of Prednisolone,
• 2mg or less of Dexamethasone
• 40mg or less of Hydrocortisone

Those on higher doses of these medications do not need to alter treatment when unwell.

What is cortisol?

Cortisol is a natural steroid hormone produced by the adrenal glands. It helps the body respond to stress, particularly during illness or injury.

Managing steroids when you are unwell

If you are on steroid treatment this may reduce your body’s own ability to increase cortisol when you are unwell. In such situations it might be necessary to increase the steroid treatment dose to help fight intercurrent illness or injury.

When to increase your steroid dose

Normally the adjustment of steroid dosing is done in conjunction with your doctor (Hospital doctor or GP). However, when unwell (any illness, injury such as broken bones or any operation) it may help you deal with this by increasing your steroids for a few days.

In these circumstances it is important to double your dose quickly. You can do this by increasing your recommended steroid dose in the following circumstances noting the advice below:

• Coughs and colds – A simple cold with a cough and “runny nose” No need to take additional steroids.
• Temperature – If you have a temperature above 37.5C. This would indicate that you have some sort of infection. Double your prescribed steroid dose for 2-3 days.
• Antibiotics – If you are prescribed antibiotics. Double your prescribed steroid dose whilst taking your antibiotics.
• Diarrhoea – Double your prescribed steroid dose until the diarrhoea stops. If you have severe diarrhoea and vomiting you may need additional medical input and you should get immediate medical advice. (From your GP, Accident and Emergency Department, NHS 24 on 111 or 999 in an emergency).

Vomiting and severe illness

• If you vomit within 1 hour of taking your steroid, take the dose again.
• If you vomit again, take double your dose and seek urgent medical advice.
• If you cannot keep medication down, get medical help immediately.
• If trained, use your emergency hydrocortisone injection.

Important advice

• Carry a steroid treatment card at all times.
• Tell healthcare staff (including dentists) that you take steroids.
• Consider wearing a medical alert bracelet or necklace.
• Ensure your GP record includes a Key Information Summary (KIS) alert.

Dental Appointments

• Check Up – No requirement to adjust dosing of steroids
• Treatment – Take double your steroid treatment dose for 24 hours.

General Anaesthetics

If you need surgery either routine or emergency it is vital that you tell the surgeons that you take steroid therapy.

Emotional Stress

Current recommendations are there is no requirement for increased steroids during periods of psychological or emotional stress.

Side effects

Steroids can be associated with a number of side effects such as: high blood pressure, diabetes, weight gain and osteoporosis. It is very unlikely that you would be at excess risk of these by increasing your dose for a few days.