EMERGENCY TREATMENT OF ADRENAL
INSUFFICIENCY
OVERVIEW OF ADRENAL INSUFFICIENCY
Adrenal insufficiency (or cortisol deficiency) can be a life-threatening condition. Those
with adrenal insufficiency require daily replacement of cortisol. Cortisol is a hormone
produced by the adrenal gland that is necessary for the body to function appropriately.
During times of stress such as illness, surgery, or accidents the body normally produces
extra cortisol to help the body recover from stress.
In patients with adrenal insufficiency, their dose of cortisol (i.e. hydrocortisone or
prednisone) must be increased to manage this stress. However, if your child is not able
to take medications by mouth and/or has an increase in stress such as surgery or an
accident it is necessary to give extra cortisol by injection. If injectable hydrocortisone
is needed as an outpatient, you need to seek emergency medical attention
immediately afterwards.
Your child should always wear a MEDICAL ALERT DEVICE that clearly states that
he/she has ADRENAL INSUFFICIENCY or similar statement on their person (such as
bracelet, necklace, etc.). A wallet card is not sufficient, as this may be misplaced in the
event of an accident. It is also recommended that his/her date of birth be included.
ENDOCRINE
EMERGENCY PAGER
888-404-4548
Emergency Treatment of Adrenal Insufficiency
Pediatric Endocrinology and Diabetes Team
Children’s Hospital at Scott & White ©
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Revised 2/12/2016
STRESS DOSING
Stress Dose your child when…
 Your child is sick with a fever ≥ 101 F.
o Stress dose for full day or until fever resolves.
 Your child is vomiting or has persistent diarrhea.
o If your child vomits, wait 30 minutes and stress dose. If your child
vomits again, give injectable hydrocortisone. DO NOT delay
giving injectable hydrocortisone.
 Your child has experienced physical trauma such as a broken bone or
concussion.
o Stress dose until problem evaluated by physician for further
instruction.
 Your child is having surgery.
o For scheduled or emergency surgery have the surgeon, dentist, or
anesthesiologist contact us directly on the emergency pager for
instructions.
 Your child is showing signs of cortisol deficiency including persistent
headache, nausea, abdominal pain, confusion, pale skin, listlessness,
dehydration, or dizziness.
o Give injectable hydrocortisone
 If in doubt, stress dose.
To stress dose your child, simply give him/her TRIPLE his/her normal cortisol dose
as instructed. For example, if your child takes 5mg hydrocortisone three times daily
increase dose to 15mg hydrocortisone three times daily. If unable to take medicine by
mouth (i.e. vomiting) or severe illness, GIVE injectable hydrocortisone (see below).
CONTACT EMERGENCY PAGER IF CONCERNS ABOUT STRESS DOSING,
IF INJECTABLE HYDROCORTISONE HAS BEEN GIVEN, OR WITH OTHER
CONCERNS RELATED TO ILLNESS OR STRESS FOR ADDITIONAL
INSTRUCTIONS.
INJECTABLE HYDROCORTISONE
The appropriate dose of injectable hydrocortisone for your child is based on their age.
Age (years)
≤3
3-12
>12
Emergency Treatment of Adrenal Insufficiency
Pediatric Endocrinology and Diabetes Team
Children’s Hospital at Scott & White ©
Dose in mg (ml)
25 (0.5ml)
50 (1ml)
100 (2ml)
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Revised 2/12/2016
STORAGE AND REPLACEMENT OF
INJECTABLE HYDROCORTISONE
For unused vials, store at room temperature
(<86 degrees) in a dark, dry area (such as a
cabinet shelf).
Once vial is opened, label the vial with date
and time. Once mixed, hydrocortisone is
good for only 24 hours. If there is any
remaining, it can be reused within 24 hours.
Continue to keep at room temperature.
Discard the remainder after 24 hours.
EMERGENCY PAGER
888-404-4548

Call 911 immediately if this call is
regarding a life-threatening
emergency.

We regard all pages to this number as nonlife-threatening emergencies; therefore,
we return calls within 15 minutes. If you
don’t receive a call back from us within 15
minutes, there may be a problem with the
pager signal. Please call the emergency
pager number back immediately and tell the
answering service that you are having
difficulty contacting us.
Check the expiration date on your injectable
hydrocortisone periodically. Contact our
office for a new prescription if the
expiration date is near.
o We are a teaching institution. The
person answering your call may be a
team staff member, or a physician in
training working under a staff
physician.
Periodically, it is worth getting additional
education on injectable hydrocortisone so
that when you need to give to your child
you are comfortable with this process.
Contact our office to arrange a time to
review injectable hydrocortisone use as
needed.
o To avoid signal problems, we prefer
that you do not leave a cell phone
number for us to call. Please
unblock your phone to unidentified
numbers.
Medical Office
Children's Hospital at Scott and White
Pediatric Endocrinology and
Diabetes Team
2401 South 31st Street
Temple, TX 76508
Phone 254-724-1492 (leave a
detailed message if no one answers)
Fax 254-724-9909
Email pediendo@swmail.sw.org
Emergency Treatment of Adrenal Insufficiency
Pediatric Endocrinology and Diabetes Team
Children’s Hospital at Scott & White ©

Requests for routine prescription
refills should never be emergencies.
Plan ahead, our office staff is generally
able to refill prescriptions same day.
However, messages left after 3:30PM
and on holidays and weekends will be
handled on the next business day.
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Revised 2/12/2016