Guidelines for the Child Who Is Cortisol or Steroid Dependent
This handout has been written to help you learn about cortisol dependency and its treatment. It also covers safety measures to follow at home. If you have any questions, please ask your nurse or doctor.
What does "cortisol dependent" mean?
Cortisol is a hormone produced by the adrenal glands. It keeps the body’s blood pressure and blood sugar from dropping too low. It helps the body deal with physical stress. Cortisol dependent means that the adrenal glands cannot make enough (or any) cortisol. Your child must take medicine to replace it.
What is the treatment?
Hydrocortisone is used to replace cortisol. You may also hear your doctors and nurses call this Cortef®. It is taken by mouth 2-3 times each day to maintain the level of cortisol in your child's body. In some cases, it may need to be injected. If your child has asthma or certain illnesses, other medicine is sometimes used.
What should you know about stress and the need for extra hydrocortisone?
In times of stress, your child must receive extra hydrocortisone. Your doctor and nurse will fully explain why this is needed. If your child does not receive the extra hydrocortisone, acute adrenal insufficiency may result. If not treated, this can lead to loss of consciousness, coma, or even death.
Physical stress in this case is defined as fever, surgery, serious injury, or significant illness that your child may have. When the body is under stress, the adrenal glands should produce extra amounts of cortisol. Because your child’s glands do not produce the extra amount needed, your child must rely on extra hydrocortisone.
What are the sick day guidelines for your child?
Extra hydrocortisone must be given during times of extreme physical stress such as fever or trauma. Your child’s stress dosing plan follows.
If your child has an illness, fever greater than 100.5°F or a minor injury or sprain, then your should give your child ________ mg of hydrocortisone, by mouth, every 8 hours.
For any of these situations, you will need to give your child the injectable medicine.
- Your child vomits and cannot take anything by mouth. This would include your child vomiting the oral dose within 30 minutes of taking it.
- Your child “looks bad” (pale, sweaty, breathing fast, very tired, not responding), has a serious injury such as a broken bone, or loses consciousness, inject the medicine as ordered and call 911.
Your child’s injectable dose will be _______ mg of _____________________.
What other points should you think about?
- It is a good idea to ask about sick day guidelines during your child’s routine visits so you can prepare for those times.
- When your child is ill, make sure he or she drinks extra fluids to prevent dehydration.
- If you child needs surgery, major dental work, or has been in an accident, large doses of hydrocortisone will often be needed. Tell the doctor or dentist that your child has cortisol deficiency before any procedure.
- You should stress dose your child on days they will be receiving immunizations or vaccinations. If they have a fever in the days after the immunizations, please refer to the stress dose guidelines.
- As a rule, emotional stress does not require increased hydrocortisone.
- It is helpful for you to review this Health Facts each month so that you will know how to follow the guidelines if your child becomes ill. At that time, you can also check the expiration date on the injectable medicine. You can be certain you have the syringes and needles that you need. Families tell us that reminders on their calendars have helped them remember this.
Your child must wear a medical identification bracelet or necklace to alert people in times of emergency that your child has a cortisol deficiency and is taking hydrocortisone.
Endocrine Clinic, Monday to Friday, 8:00am to 4:30 pm (608) 263-6420.
Nights, weekends, & holidays: Call to (608) 263-6420. This will give you the paging operator. Ask for the pediatric endocrine doctor on-call. Leave your name, and phone number with the area code. The doctor will return your call.
If you live out of the area, please call 1-800-323-8942.
The Spanish version of this Health Facts for You is #6539.
The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.
Last Updated: 11/22/2011
Copyright © 11/21/2011 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#4424
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