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CORTICOSTEROID REPLACEMENT THERAPY
The body naturally produces hormones called ‘steroids’ mainly cortisol from the adrenal glands which lie just above your kidneys. Corticosteroids are medicines designed to act in the same way as ‘steroids’ and are used to replace the body’s own production when the adrenals are not working normally.
When is corticosteroid replacement required?
This replacement is required in conditions such as Addison’s where the adrenals stop working or after both adrenals are removed (adrenalectomy) or in hypopituitarism where the signal from the pituitary gland in the brain is faulty and fails to switch on the adrenals. Another reason may be that the patient has had previously high doses of steroids for some severe condition (e.g. asthma, crohn’s disease, rheumatoid arthritis) which has suppressed the adrenals so that they fail to switch back on when the high dose of steroid is removed (known as prolonged suppression).
What corticosteroids are used?
The most usual replacement is with hydrocortisone but occasionally predisolone or even dexamethasone are used. If the adrenal has failed completely then another hormone which retains salt is required called fludrocortisone. This is required in Addison’s, after bilateral adrenalectomy but never in hypopituitarism and never after prolonged suppression.
When should a patient take the steroids?
Replacement corticosteroids are usually taken twice daily. Often the dose taken in the morning will be larger than the late afternoon dose to try and mimic how the body naturally produces cortisol. However some patients report tiredness in the afternoon which may be helped by taking hydrocortisone at breakfast, lunch and dinner. The steroid should always be taken with or after food. Some patients have a condition where they rapidly metabolise hydrocortisone and need longer acting steroid. In such situations prednisolone or even dexamethasone may be prescribed instead of hydrocortisone.
What if a dose is missed by mistake?
One dose missed is unlikely to cause a problem but missing two dosages could land you in hospital. Try to remember.
What if another illness occurs?
If you become ill then the body naturally would increase the output of steroid from the adrenals. Therefore if you are on replacement steroid it is essential to mimic the natural response by doubling your dose of steroid until the illness is over.
What illnesses require extra replacement steroid?
1. Flu
2. Severe head cold
3. Infection
4. Fevers
5. Surgery
6. Dental surgery
7. Severe accidents
If you have diarrhoea or vomiting then you might not absorb your steroid even if you have doubled the dose so best to seek advice urgently from your GP or call at A+E. Remember you MUST see a doctor that day when you have diarrhoea or vomiting.
Who should you tell about your replacement steroid?
It is vital that you carry a card or a Medi-alert bracelet or pendant stating that you are on steroid for if an accident occurs then it is essential that the hospital knows about this medicine straight away. Mention this to your relatives and friends so that they too can alert the doctors to this need.
Usually there are few side effects when steroids are taken as replacement medicine. Some patients can develop stomach upset which is the reason why you are asked to take the medicine with food or after food but not on an empty stomach. If indigestion still occurs then other special medication to prevent this may be required. Remember not to stop the steroid because of indigestion or you will become extremely unwell within 24hrs.Contact your doctor promptly.
Ó NHS Tayside; 2006; version 1.0
Disclaimer; no liability whatsoever is accepted for information given and all such information, especially with regard to drug usage (UK version provided), must be checked with a person’s health provider.