Addison’s disease

Although these symptoms aren’t always caused by Addison’s disease, you should see your GP if you have them so they can be investigated. As well as a synacthen stimulation test, your thyroid gland may also be tested to see if it’s working properly. You’ll also be tested for low blood pressure (hypotension) while you’re lying down and again shortly after you stand up.

Not everyone with coronavirus will need this steroid – it’s used in hospital or in virtual wards when someone is really unwell and needs help to breathe. It works by reducing the inflammation that coronavirus can cause and supports your immune system to fight it. In some cases, severe dehydration and very high blood sugar levels can mean that you need to go into hospital.

Symptoms of Addison’s disease

The ADSHG advises you always to have 3 months’ supply available of your essential steroid medicine. This is in case you need to increase your dose to follow your sick day rules, or to cover if there is a shortage of your medicine. If you have Addison’s disease, you’ll need to take steroids on a long-term basis, so you should keep a steroid emergency card with you at all times. Minor ailments can affect anyone with a steroid-dependent adrenal condition very differently.

Your endocrinologist will discuss with you when an injection might be necessary. If an adrenal crisis is not treated, it can lead to a coma and death. There is also a risk your brain will not get enough oxygen if treatment is delayed, which can cause permanent disability.

Helping you to manage your health

An extra dose will not do any harm, so if in doubt it is better to give extra hydrocortisone and then contact the specialist endocrine team for advice about what to do next. The alert asks healthcare providers to ensure all eligible patients are issued with a Steroid Emergency Card. People who don’t have diabetes just produce more insulin to cope.

The adrenal gland is damaged in Addison’s disease, so it does not produce enough cortisol and aldosterone. Here is some helpful information on the prevention and emergency management of adult patients with adrenal insufficiency that accompanies the NHS Steroid Emergency Card. If you need to administer emergency hydrocortisone, always call your GP immediately afterwards.

Some conditions, like Addison’s disease, severe asthma, rheumatoid arthritis, lupus and coronavirus are treated with steroids. If you have diabetes, taking high doses of steroids for periods of time can make your blood sugar levels rise. They may ask you to make some changes to how you manage your diabetes, so that you can keep your blood sugar levels within your target range. Some patients who take steroids orally, through an inhaler or topically for other medical conditions may also develop secondary adrenal insufficiency and become steroid dependent.

If they are moderately unwell (see table) then double their dose of steroids. However, if your child is being sick within 1 hour of taking their hydrocortisone tablet then give a 2nd dose of hydrocortisone. If a someone cannot make cortisol (cortisol deficiency), they will need to take tablets to replace it.

Sick Day Medication Rules

Things like vomiting, diarrhoea, colds and flu could cause an adrenal crisis. It’s important that you spot the early symptoms of a bug or cold and adjust your steroid replacement medication. Wearing a medical alert bracelet will inform any medical staff treating you about your condition and what medication you require. A medication called hydrocortisone is usually used to replace the cortisol.

Steroid replacement for adrenal insufficiency

Steroid replacement is vital for your child to grow and develop normally. This is because the treatment is just replacing what the body should normally produce. All patients requiring a dose of IM or IV hydrocortisone must be observed for at least 6 hours and have kept down at least one oral sick day dose prior to discharge.

You can download and carry it with you, or you could use the image of the card as a screensaver on your mobile phone to show healthcare teams in an emergency. If you have Addison’s disease, you’ll need to take daily medicine to replace the lost hormones. This could be necessary if you go into shock after an injury, or if you experience vomiting or diarrhoea and are unable to keep down oral medication.

Adrenal crisis

Children with Addison’s disease may experience puberty later than usual. It can affect people of any age, although it’s most common between the ages of 30 and 50. Community and hospital pharmacies should ensure they can source and supply Steroid Emergency Cards to replace those lost by patients or become damaged. For more information, download the National Patient Safety Alert PDF document.