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What precautions are needed if I have adrenal insufficiency?

Diana Meeks
Diana Meeks on behalf of Sigma Nursing
Family Practitioner

You need to have precautions for the following cases:

Surgery
Because cortisol is "stress hormone," people with chronic adrenal insufficiency who need any type of surgery requiring general anesthesia must be treated with intravenous glucocorticoids and saline. Intravenous treatment begins before surgery and continues until the patient is fully awake after surgery and able to take medication by mouth. The "stress" dosage is adjusted as the patient recovers until the presurgery maintenance dose is reached.

In addition, people who are not currently taking glucocorticoids but who have taken long-term glucocorticoids in the past year should inform their doctor before surgery. These people may have sufficient adrenocorticotropic hormone (ACTH) for normal events, but they may need intravenous treatment for the stress of surgery.

Illness
During an illness, oral dosing of glucocorticoid may be adjusted to mimic the normal response of the adrenal glands to stress on the body. Significant fever or injury may require triple oral dosing. Once recovery from the stress event is achieved, dosing is then returned to maintenance levels. People with adrenal insufficiency should know how to increase medication during such periods of stress. Immediate medical attention is needed if severe infections, vomiting, or diarrhea occur. These conditions can precipitate an Addisonian crisis.

Pregnancy
Women with adrenal insufficiency who become pregnant are treated with standard replacement therapy. If nausea and vomiting in early pregnancy interfere with taking medication by mouth, hormone injections may be necessary. During delivery, treatment is similar to that of people needing surgery. Following delivery, the dose is gradually tapered and the usual maintenance doses of oral hydrocortisone and fludrocortisone acetate are reached about 10 days after childbirth.

This answer is based on source information from the National Institute of Diabetes and Digestive and Kidney Diseases.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.