During the coronavirus (COVID-19) pandemic, every Australian has been asked to take extra care to avoid becoming ill or unknowingly spread the virus to others. This is especially important to avoid people at high-risk of becoming seriously ill getting infected. This includes people with pre-existing health conditions, such as adrenal insufficiency.

Adrenal insufficiency can be caused by a problem with the adrenal glands themselves (Addison’s Disease), or because a disorder of the pituitary gland means it does not stimulate adrenal hormone production (Hypopituitarism). One of the key hormones affected is cortisol. This hormone is best known for its role in helping the body respond to stress, including infections, injury and illness.

The main treatment for adrenal insufficiency is glucocorticoid replacement therapy, usually with hydrocortisone, cortisone acetate or prednisolone. These medications replace or restore cortisol to an adequate level.  However, during illness, stress, trauma, injury or infection the body needs more cortisol than usual to survive.  It is critically important to increase the dose at these times to avoid an emergency situation caused by adrenal crisis.

Treatment advice

Follow the physical distancing restrictions in your state

For people with adrenal insufficiency who take glucocorticoid replacement therapy, it is important to take advice about physical distancing seriously. This includes following the advice and restrictions in your state. These can be found here.

This is because the virus spreads from person to person and can survive on surfaces where an infected person has been. Following the restrictions is the best way to avoid becoming infected and prevent the potentially serious consequences.

Washing your hands with soap and water, covering coughs and sneezes with your elbow, using alcohol-based sanitisers and avoid touching your face, eyes, nose and mouth will all prevent the coronavirus from spreading.

If you start to feel unwell, follow your ‘sick day’ plans

If you are taking glucocorticoid replacement therapy, it is vitally important to know your ‘sick day’ rules. These will be the instructions your doctor gave you about increasing your glucocorticoid dose if you become sick or have an injury or are under significant acute stress. These instructions need to be followed during the COVID-19 pandemic.

These include:

  1. If you get a dry cough, sore throat, fever or breathlessness, you should immediately double your daily glucocorticoid replacement dose, and continue taking this until the fever has gone. If you start to feel worse, use your injectable hydrocortisone (Solu-Cortef) and seek urgent medical care (go to the emergency department of the hospital).
  2. If you start to experience vomiting or diarrhea and cannot keep your glucocorticoid replacement therapy down, use your injectable hydrocortisone (Solu-Cortef) and seek urgent medical care (go to the emergency department of the hospital).
  3. Wear your Medic Alert bracelet so that if you need medical attention the doctor will know you are taking glucocorticoid replacement therapy
  4. Ensure you have one month’s supply of oral glucocorticoid therapy and injectable hydrocortisone (Solu-Cortef) at home for emergency situations.

If you are well, keep taking your normal daily dose

If you are feeling well, there is no need to increase your normal daily glucocorticoid dose. In fact, increasing your dose when you don’t need to may cause harm. This is because glucocorticoids can reduce the activity of the immune system, the body’s defence against viruses. Only increase the dose if you start to feel unwell or show symptoms.

Key message

If you are taking glucocorticoid replacement therapy for adrenal insufficiency, stay on your usual replacement dose that keeps you well, but increase the dose the moment you get a fever or other infective symptoms.

 

Expert Review

The medical content in this article has been reviewed by A/Professor Morton Burt, A/Professor Warrick Inder and A/Professor Ann McCormack. A/Prof Burt is an Endocrinologist in the Southern Adelaide Diabetes and Endocrine Service, SA, and the Honorary Secretary of the Endocrine Society of Australia. A/Prof Inder is an Endocrinologist at Princess Alexandra Hospital, Qld, and the Past President of the Endocrine Society of Australia. A/Prof McCormack is an Endocrinologist at St Vincent’s Hospital, NSW, and is a Council member of the Endocrine Society of Australia.

 

The physical distancing advice in this article was updated on 4 May 2020, in light of the differences in restrictions imposed by different states and territories.