Coronavirus recommendations for patients with Addison’s disease

Advice is as follows:

1. You are not immunocompromised – you are on replacement dose steroids and not treatment dose. You should therefore carry on your normal dose unless you are unwell.

2. Ensure that you have adequate emergency supplies, including a hydrocortisone injection at home (check it is in date), and anti-nausea tablets/suppositories.

3. It is sensible to register with your local ambulance service as “steroid dependent”. There is advice on how to do this here:

4. If you become unwell you should follow the sick day rules –
a. Double your dose if temperature >37.5oC
b. Treble your dose if temperature >39oC
c. You do not need to increase your fludrocortisone dose (the higher dose of hydrocortisone will provide enough mineralocorticoid effect)

5. Only <5% of people have vomiting or diarrhoea associated with corona virus. However, the usual rules apply:
a. Take an anti-nausea tablet or suppository as soon as possible
b. Retake double the hydrocortisone dose and see how long it stays down
c. Have an adult friend with you in case you deteriorate suddenly
d. If further vomiting occurs then administer your emergency IM hydrocortisone and go immediately to the nearest hospital for intravenous fluids and hydrocortisone: explain that you are experiencing an adrenal crisis and you need urgent intravenous steroids and fluid.

If you do have symptoms of corona virus without vomiting or diarrhoea then the usual advice applies: at present the advice is that you should self-isolate at home for 14 days – this advice is changing constantly and you should follow the standard government NHS advice.

You should continue your “sick day” dose of hydrocortisone as above and stay well hydrated until you recover. Regular paracetamol, and not ibuprofen/other anti-inflammatories are recommended.

You should only attend hospital if the severity of the symptoms means that you are unable to safely cope at home. If you are severely unwell then call 999. If not, but you think you still need to be admitted then you should call 111 – this allows you to be diverted to the correct area of A+E to avoid the infection of other (potentially very vulnerable) patients.

There is further useful information on managing your Addison’s disease here:

Coronavirus recommendations for patients with Addison’s disease