Corticosteroid Replacement Therapy

Treatment
You are taking replacement Hydrocortisone tablets (or alternatively – prednisolone or dexamethasone tablets), because your adrenal glands are no longer able to produce enough of the hormone Cortisol. This may be because of a problem with the adrenal glands themselves, or because of a problem with your pituitary gland.

If you are taking Hydrocortisone three times daily, you should normally take the first dose on waking, the second dose at lunchtime and the third dose around 4.00pm to 6.00pm.

If you are taking Hydrocortisone twice daily, you should normally take the first dose on waking and the second dose around 4.00pm to 6.00pm. We recommend that you take the Hydrocortisone tablets with milk/food as this may prevent an upset stomach or heartburn.

Sick Day Rules – if you are feeling unwell
During an illness, infection or operation, the body normally produces an increased amount of cortisol. This helps the body recover from the stresses of the illness. Since your adrenal glands cannot respond to an illness in the normal way, you should increase the Hydrocortisone/Prednisolone/Dexamethasone dose at times of illness in the following way:

• If you have a severe cold, flu, other infection or fever (high temperature) or are unwell, you should double each of your Hydrocortisone doses for about three to five days or until the illness has settled. Please see attached Hydrocortisone information leaflet for further advice. If you take Dexamethasone or Prednisolone you should double each of these doses. If you continue to be unwell, your doctor/endocrine specialist nurse may decide that you need to treble each of your Hydrocortisone doses. Please contact the endocrine team/GP for advice.
• If you are seriously ill, or if you have vomiting and diarrhoea, the tablets may not be effective on their own. You must seek medical advice early from the endocrine team (contact details can at the end of this leaflet) because you may need an injection of Hydrocortisone. At this point you may require admission to hospital until your symptoms settle.

You will be provided with an emergency Hydrocortisone pack which you should keep at home at room temperature. Please make sure this is in date by checking the expiry date. Your GP/Endocrinology team/Emergency Department will decide if you require this injection and administer it for you.

If you require an operation or are involved in an accident, it is very important that the doctors/paramedics know about your Hydrocortisone/Prednisolone/Dexamethasone tablets in this situation.

You should carry a steroid warning card (this is provided in your emergency injection pack) or a medic alert pendant at all times.

Travel
If you are away from home or abroad, it is important to take additional Hydrocortisone tablets with you. You will need to take two emergency Hydrocortisone injection packs and this information leaflet with you in case you become unwell.

If you are travelling abroad, the endocrine specialist nurses can provide you with a holiday letter which may be required at the airport.

Contact Details
If you have any questions, or the advice has failed to control your symptoms, you should contact Specialist Nurses in Endocrinology Tel. 01274 382019 Monday – Friday between 8.00am and 4.00pm except Bank Holidays.

For out of hour’s enquiries you must contact a GP/NHS 111 Service/999.