Adrenal Insufficiency and Steroid Dosing Guidelines
April 10, 2020
• When individuals with adrenal insufficiency (AI) are not sick and therefore not requiring stress dosing, they should not be taking higher or lower doses of hydrocortisone hoping it will protect them from getting sick. They should continue take their regular replacement dose as prescribed unless otherwise instructed by their physician.
• If they do get sick, increase the dose following stress dosing guidelines; you can find these guidelines on NADF’s website:

o Illness with fever >100.4-102°F Double hydrocortisone replacement dose until recovery (~2-3 days)
o Fever >102.2°F Triple hydrocortisone replacement dose until recovery (~2-3 days)
• If an acute condition develops, and the patient needs to be on a ventilator, the steroid dosing will depend on the specific circumstances of each individual. Generally, for ventilated patients, they will use stress dose IV hydrocortisone 100 mg every 8 hours, but there may be situations where a lower or higher dose may be appropriate.
• Individuals with all types of adrenal insufficiency, both primary and secondary Adrenal Insufficiency, should exercise extra precautions, and follow the CDC recommendations for individuals at higher risk.

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