HF 4424

Guidelines for Cortisol or Steroid Dependent Children

This handout is to help you learn how to care for your child who is cortisol dependent. 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 that 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 your body cannot make enough (or any) cortisol. Your child must take medicine to replace it.

What is the treatment?

We use hydrocortisone to replace cortisol. You may also hear your doctors and nurses call this Cortef®. Your child should take it 2-3 times each day by mouth. Sometimes you may need to inject your child with a dose. If your child has asthma or some other illness, they may need other medicine.

How does stress affect my child?

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 doses, it may lead to acute adrenal insufficiency. If not treated, this can lead to loss of consciousness, coma, or even death.

When the body is under stress, it should make extra cortisol. Because your child’s body does not make the extra amount needed, your child needs extra doses.

What is physical stress?

  • Fever

  • Surgery

  • Vomiting

  • Serious injury

  • Serious illness

What are the sick day stress dose guidelines for my child?

You must give your child extra doses during times of extreme stress to their body such as fever or trauma. Your child’s stress dosing plan is listed below.

Give your child ________ mg of hydrocortisone, by mouth, every 8 hours if your child:

  • Has an illness

  • Has a fever greater than 100.5°F

Give your child ________ mg of hydrocortisone, by mouth, every 8 hours if your child:

  • Has a minor injury or sprain

Inject your child with _______ mg of _____________________ if your child:

  • Vomits and cannot take anything by mouth. Your child vomits the oral dose within 30 minutes of taking it.

  • “Looks bad” (pale, sweaty, breathing fast, very tired, not responding).

  • Has a serious injury such as a broken bone.

  • Loses consciousness, call 911 after you inject the medicine.

Other Guidelines

Ask about sick day guidelines during your child’s routine visits so you can be ready.

When your child is ill, make sure to give extra fluids.

If your child needs surgery, major dental work, or has been in an accident, they will often need large doses of hydrocortisone. Tell the doctor or dentist that your child has cortisol deficiency before any procedure.

You should stress dose children under 2 on days they will be getting vaccines. You will need to stress dose your child (of any age) if your child gets a fever after a vaccine.

Emotional stress does not require extra doses.

Review this Health Facts each month so you will know how to follow the guidelines if your child becomes ill. Also check the date on the injectable medicine monthly to see when it expires. Make sure you have the syringes and needles that you need. Put a note on your calendar to help you remember.

Your child must wear a medical alert bracelet or necklace in case of an emergency.

Who to Call

Endocrine Clinic, Monday to Friday, 8:00am to 4:30pm: (608) 263-6420.

After hours call (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 call you back.

The toll-free number is: 1-800-323-8942.

If you are a patient receiving care at UnityPoint – Meriter, Swedish American or a health system outside of UW Health, please use the phone numbers provided in your discharge instructions for any questions or concerns.