Adrenal Insufficiency and Crisis

The adrenal glands sit on top of the kidneys and produce a hormone (cortisol) that helps the body deal with stress (i.e., severe illness or injury). While you are taking daily steroids, the adrenal glands stop producing cortisol (called “adrenal insufficiency”) and become inactive. If steroids are discontinued, it can take weeks or months for your body to begin making cortisol again. Without cortisol, your body is unable to deal with stress, resulting in “adrenal crisis” which may be life threatening. For this reason, you should never stop your daily steroids suddenly (or without a doctor’s help) or miss doses for more than 24 hours.

In addition, when your body is under additional stress (e.g. high fever, surgery, fractures) additional doses of steroids, or stress doses may be needed. Information for stress dosing and recognising/treating/preventing acute adrenal insufficiency can be found in the PJ Nicholoff Steroid Protocol, available here: