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 ofCOVID-19 (fever >38°C (>100 F), a new orcontinuous dry cough, sore throat, loss of senseof smell or taste, aches and pains, fatigue) Adults and adolescents should take 20 mg hydrocortisone orally every 6 hours (in children, their usual daily doseshould 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 mgorally every 6 hours Patients on 5-15 mg prednisolone daily should take 10 mg prednisolone every 12 hours; patients on oralprednisolone >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 clinicaldeterioration (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 tohospital If patients cannot be taken or kept in hospital, then they should take 50 mg hydrocortisone every 6 hours orally athome; 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 orsupported by continuous positive airwaypressure (CPAP) respiration or mechanicallyventilated Hydrocortisone 100 mg per iv injection in adults and adolescents, followed by continuous iv infusion of 200 mghydrocortisone/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 ininfants 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.