Title: Sick Day Rules in Adrenal Insufficiency

Written by
Dr. Gyabina Maharjan

Dr. Pratik Gyawali
Dr. Lubna Mirza

What are the adrenal glands?

Adrenal glands are the endocrine glands that are present on top of each kidney. They produce lifesaving hormones responsible for maintaining sugar, salt and water levels and preparing the body to face stressful situations. Adrenal glands also play a role in maintaining external features like hairs on the body.

What is adrenal insufficiency?

Adrenal insufficiency is the state in which adrenal glands are unable to produce the life saving hormones as mentioned above. This causes a shock-like situation where a person is unable to maintain normal blood pressure or sugar levels to deal with acute illness.

What is the significance of  a sick day in a patient with adrenal insufficiency?

The normal adrenal glands can increase the production of stress hormones when a person is sick. A patient with adrenal insufficiency who is on a fixed dose of steroid will need to manually increase this dose to overcome illness.

What are some of the examples of steroids?

Generally, patients with adrenal insufficiency take hydrocortisone 10mg oral twice daily. Some other examples of steroids are prednisone, dexamethasone and methylprednisolone. Steroids can be taken by mouth, intramuscularly or intravenously depending on the situation.

We can tell if a person is suffering from adrenal insufficiency with the following signs and  symptoms. If not treated quickly, these patients can develop a life threatening adrenal crisis.

*   Low blood pressure

*   Feeling dizzy or light-headed

*   Fever, shivering or feeling very cold

*   Nausea and /or vomiting

*   Feeling very weak

*   Extreme tiredness, drowsiness or confusion

*   Aching muscles and/or joints

*    Stomach ache

*   Severe diarrhea

How can we prevent an adrenal crisis?

Patients should be educated about the signs and symptoms of adrenal insufficiency. They need to have an adequate supply of steroid medication at home to be able to increase dose when needed. First try doubling the dose. If it’s not enough, then triple the dose. If they are unable to take medicine by mouth, an emergency rescue injection of steroids may be necessary. It is an important part of adrenal insufficiency treatment to educate family members as well so they can deal with the emergent situations. All patients with adrenal insufficiency should wear a medical alert bracelet that is clearly visible. If a patient is not feeling better after initial emergent care, they should be taken to the hospital.

Patients will need to increase the dose of steroids in the following conditions.

Illness with fever



Pregnant women going through labor

Dental surgeries

Any surgeries or invasive procedures

How would people know if they need to further increase the dose of steroids?

Patients will need to keep an eye on their blood pressure and heart rate. Also, how they feel. If they continue to feel bad with the stress of illness or surgery, they will need to increase the dose further.

Note: This paper is written for general education. It doesn’t take the place of advice by your primary care physician. Regular follow ups with a licensed healthcare provider is recommended.

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