Primary Adrenal Insufficiency sick day rules

Detailed instructions for sick day and emergency management of adrenal insufficiency. Refer to the table below.

Summary of Adrenal Insufficiency Sick Day Rules

Maintenance (Usual) Doses

  • Take these doses on a daily basis when well
Sick Day Management (“Stress Dosing”)

  • With any physical stress such as infection or injuries, the body need higher amounts of hydrocortisone
  • In the event of fever (above 38 Celsius or 100.4 Fahrenheit), infection that requires antibiotics, vomiting, diarrhea, or fracture, use the higher doses for 24 to 48 hours
  • Resume usual (maintenance) doses of hydrocortisone when fever/stress has resolved
  • Stress dose is typically double or triple usual daily dose. Call Endocrinology Team
Emergency Management
(Solu-Cortef Injection)

  • When unable to tolerate oral medication, hydrocortisone by injection will be necessary
  • In the event of severe illness, trauma, inability to tolerate oral hydrocortisone, unconsciousness, or repeated vomiting, administer Solu-Cortef by intramuscular injection


Solu-Cortef (100 mg in 2 mL)

  • Age under 3 years → administer 25 mg (0.5 mL) by intramuscular injection
  • Age 3-10 years → administer 50 mg (1 mL) by intramuscular injection
  • Age above 10 years → administer 100 mg (2 mL) by intramuscular injection

Go to the emergency Department or call 911

 Call Endocrinology Team

Preparation for Surgery

  • The stress of surgery and recovery from it necessitates higher doses of hydrocortisone during and 1-3 days after surgery
  • This requires team approach among the healthcare professionals managing the surgery and post-operative care
Make the surgeon (or dentist) and anesthesiologist aware

  • Diagnosis of adrenal insufficiency and medication doses

Surgical team and endocrinology should communicate with each other

  • Plan well before the date of surgery
  • Decide on hydrocortisone doses before and after surge

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The MyEndoconsult Team. A group of physicians dedicated to endocrinology and internal medicine education.

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