Addison’s Disease Questions and Answers

All questions answered by a Professor in Endocrinology

The following questions and answers should be used for guidance only

Q: I have booked to have my wisdom tooth out and any advice would be welcome regarding extra hydrocortisone

A: My advice in relationship to removal of teeth is that, if any general anaesthetic is to be given, the patient should receive an intra-muscular injection of hydrocortisone 100mg 30-60 minutes prior to the procedure. That is all that needs to be done. If the treatment is to be under a local anaesthetic, then the patient should take an extra 20mg oral dose of hydrocortisone 30-60 minute before.

Q: I have had Addison’s Disease for 15 years and never had an emergency injection kit. Should I carry one? I cycle 5 miles daily.

A: I believe all patients with Addison’s Disease should have an emergency injection kit of hydrocortisone with a 100mh ampoule of drug with necessary. I syringes and swabs etc so that it can be given urgently. I usually have the patient’s relative or partner trained in how to give the injection if there is no easily accessible medical assistance. It is not necessary to carry the ampoule around but it is wise to take it with you on holiday abroad.

Q: Why am I on cortisone acetate rather than hydrocortisone, are they the one and the same thing?

A: Few endocrinologists now use cortisone acetate – they prefer hydrocortisone. Cortisone acetate was the original glucocortoid replacement Cortisone itself is inactive and has to be converted to hydrocortisone and its conversion is very variable. The absorption of cortisone is also more variable than hydrocortisone. Thus most endocrinologists prefer to use hydrocortisone. This should be discussed with your endocrinologist. In countries in the world where hydrocortisone is not available cortisone is still used.

Q: What effect would having too much hydrocortisone have on a person with Addison’s Disease?

A: Too much hydrocortisone in anyone including patients with Addison’s Disease would give the features of the condition called Cushing’s Syndrome. This would depend upon the amount fo extra hydrocortisone or other coriscosteriods taken. It would include weight gain, muscle weakness, high blood pressure, thin skin, inability to cope with infection, mental problems particularly in agitated depression, diabetes mellitus (sugar diabetes), fluid retention and thinning bones. This does not happen if the hydrocortisone levels of the blood are monitored so that excessive exposure is prevented.

Q: I take 100mg of fludrocortisone and 10mg of hydrocortisone on rising each day (6.30am) and 10mg hydrocortisone in the evening (6.30pm), I am flying to the USA later this year, how do I go about dealing with the change of times?

A: I advise my patients with adrenal deficiency who are crossing time zones to take an extra 10mg of hydrocortisone each 6 hours until they arrive, with a final dose within an hour of arrival. They should then take their normal tablet regime according to the local clock.

Q: Do Addison’s patients need to eat more salt because of electrolyte imbalance?

A: Patients with Addison’s Disease who are properly replaced with hydrocortisone and fludrocortisone do not need to eat any more salt than normal.