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  • COVID-19: Clinical Management guidance: Adrenal Insufficiency

COVID-19: Clinical Management guidance: Adrenal Insufficiency

Read SfE advice statement

For Healthcare Professionals: Suggested management and hydrocortisone stress dose cover in patients with adrenal insufficiency and suspected or confirmed COVID-19 infection.

Please also ensure Patient Advocacy is provided via the patient's own Endocrinology team and over the phone with their formal or informal carers. This should be carried out through education of the ‘sick day’ rules, helping to equip patients with sufficient glucocorticoid supplies and up-to-date steroid emergency self-injection kit and empowerment to carry a steroid emergency card and follow COVID-19 guidelines.

Clinical Scenario Suggested Management
At home
Onset of signs and symptoms suggestive of
COVID-19
(fever >38°C (>100 F), a new or
continuous dry cough, sore throat, loss of sense
of smell or taste, aches and pains, fatigue)
 Adults and adolescents should take 20 mg hydrocortisone orally every 6 hours (in children, their usual daily dose
should be trebled (i.e. 3fold increase) and administered in four equal doses every 6 hours)
 Patients on modified release hydrocortisone should switch to immediate release hydrocortisone and take 20 mg
orally every 6 hours
 Patients on 5-15 mg prednisolone daily should take 10 mg prednisolone every 12 hours; patients on oral
prednisolone >15 mg should continue their usual dose but take it split into two equal doses of at least 10 mg each.
 If on fludrocortisone, continue at usual dose
 Take paracetamol 1000 mg every 6 hours for fever (adjust dose appropriately for infants and children)
 Rest, drink regularly and monitor how concentrated (dark) urine looks is to guide further fluid intake
 Request medical advice on the suspected COVID-19 infection
Onset of signs and symptoms of clinical
deterioration
(dizziness; intense thirst;
shaking uncontrollably; drowsiness, confusion,
lethargy; vomiting; severe diarrhoea;
increasing shortness of breath, respiratory rate
>24/min , difficulty speaking
 Immediately inject (patient or carer) 100 mg hydrocortisone per intramuscular injection in adults and adolescents
(25 mg in infants, 50 mg in school children)
 Call for emergency medical attention for treatment and transfer to hospital, consider making their own way to
hospital
 If patients cannot be taken or kept in hospital, then they should take 50 mg hydrocortisone every 6 hours orally at
home; if possible, they should receive i.v. hydrocortisone and an isotonic saline infusion in the admissions unit
At hospital
On regular ward or intensive care ward,
irrespective of whether breathing unaided or
supported by continuous positive airway
pressure (CPAP) respiration or mechanically
ventilated
 Hydrocortisone 100 mg per iv injection in adults and adolescents, followed by continuous iv infusion of 200 mg
hydrocortisone/24h (alternatively 50 mg every 6 h per intravenous or intramuscular bolus injection)
 Infants and children should receive an initial parenteral injection of 50 mg hydrocortisone/m2 (usually 25mg in
infants and 50 mg in children) followed by 50 mg/24h in infants and 100 mg/24 h in children
 Pause fludrocortisone in adults
 Continuous intravenous fluid resuscitation with isotonic saline; regularly check urea & electrolytes
Recovery; improving respiratory function,
reducing or normal temperature
 Gradual tapering of stress dose hydrocortisone down to double regular replacement dose at time of discharge
(endocrinologist to advise)
 Re-start usual fludrocortisone dose in adults when total daily hydrocortisone dose <50 mg

We are grateful to the authors of the below guidance for producing this guidance. 

Click here to be taken to the latest Society for Endocrinology COVID-19 advice statement, with a summary to help keep adrenal insufficiency patients safe during the COVID-19 

Please also ensure Patient Advocacy is provided via the patient's own Endocrinology team and over the phone with their formal or informal carers. This should be carried out through education of the ‘sick day’ rules, helping to equip patients with sufficient glucocorticoid supplies and up-to-date steroid emergency self-injection kit and empowerment to carry a steroid emergency card and follow COVID-19 guidelines.

 

For the latest coronavirus guidance, please click here.

Published: 22nd April, 2020

Updated: 13th April, 2021

Author: Vick Smith

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The information contained within this website is not intended to provide clinical diagnosis and/or personalised medical advice. It should not be treated as such. Always seek the advice of your doctor or a health care professional before starting any new treatment for your underlying condition. While we have taken every care to compile accurate information to reflect the current state of knowledge, we cannot guarantee its correctness and completeness. The information provided in this website does not constitute business, medical or other professional advice, and is subject to change. In no event will the Addison’s Disease Self-Help Group or any of the contributors be responsible or liable directly or indirectly, for damages or liabilities relating in any way to the use (or misuse) of information contained within or referred to in this website.

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