9
Figure 3. Management of Patients at Risk of or With
Diagnosed Glucocorticoid-Induced Adrenal
Insufficiency With Suspected Adrenal Crisis or
During Exposure to Stress
Patients at risk of
or with diagnosed
glucocorticoid-induced
adrenal insufficiency
1
Continue hydrocortisone infusion (or parenteral administration of other glucocorticoids) only in
patients with confirmed adrenal crisis.
2
e need for extra glucocorticoid cover and the regimen used must be guided by individual patient
requirements and clinical judgment.
Suspected adrenal
crisis
Prolonged vomiting/
diarrhea without
hemodynamic
instability
(e.g., gastrointestinal
illness)
Moderate to major
stress
(e.g., severe acute
illness requiring
hospital admission;
major acute
trauma; surgery and
procedures requiring
general or regional
anesthesia with nil by
mouth or expected
long recovery time;
labor and vaginal
delivery; cesarean
section)
Minor stress
(e.g., illness with fever
or infection treated
with antibiotics not
requiring hospital
admission; significant
emotional stress;
minor surgery and
procedures requiring
local anesthesia)
Hydrocortisone 100 mg
injection I.V. or I.M. followed
by hydrocortisone 200 mg
infusion over 24 hours
1
(or
equivalent doses of other
parenteral glucocorticoids)
Absorption of oral glucocorticoids may be reduced.
Consider parenteral glucocorticoids to prevent adrenal
crisis (examples of regimens that can be used are
shown in Table 8).
2
Parenteral glucocorticoids are required until the stress
has resolved to prevent adrenal crisis (examples of
regimens that can be used are shown in Table 8).
2
Extra glucocorticoids are typically not needed for
patients already taking predniso(lo)ne-equivalent
doses ≥10 mg daily. Other patients should increase
their daily glucocorticoid dose until the stress has
resolves (examples of regimens that can be used are
shown in Table 8).
2
Fluid resuscitation
with 0.9% saline
solution (or equivalent)
guided by individual
patient needs and
comorbidities
+
