Rheumatology - Steroid-induced adrenal insufficiency and adrenal crisis in rheumatology patients

You have been given this leaflet as you currently take steroid tablets which put you at risk of adrenal insufficiency.

What are steroids?

Steroids are hormones produced by the adrenal glands, which are found on top of your kidneys.

They are important for many of your body’s processes. Cortisol is an example of a steroid; prednisolone is a man-made version of cortisol.

Prednisolone is used to treat many rheumatological conditions including rheumatoid arthritis, SLE, giant cell arteritis and polymyalgia rheumatica. Steroids have anti-inflammatory and immunosuppressive properties which make them perfect for treating inflammatory and autoimmune conditions.

What is adrenal insufficiency?

Adrenal insufficiency describes a state where your adrenal glands are no longer able to produce enough steroids to support all your body’s processes. There are many causes of adrenal insufficiency but taking steroids tablets is the most common cause in rheumatology patients. When you take steroids for a long period, your adrenal glands become lazy, and they stop producing their own steroids.

People on more than 5mg prednisolone daily for more than 4 weeks are at risk of adrenal insufficiency. You might also be at risk if you have frequent steroid injections e.g. into your muscle or joints.

What is an adrenal crisis?

An adrenal crisis is when your body’s demand for steroid hormones such as cortisol is more than the cortisol available to it due to your adrenal glands not producing steroids. This can occur if you become unwell or undergo major surgery.

Symptoms of adrenal crisis

• Low blood pressure
• Feeling dizzy, or lightheaded
• Fever, shivering or feeling very cold
• Nausea and/or vomiting
• Feeling very weak
• Extreme tiredness, drowsiness or confusion
• Aching muscles and/or joints
• Stomach ache
• Severe diarrhoea

What are ‘Steroid Sick Day Rules’?

When you are unwell, we know that your body requires more steroids to function and aid recovery. Patients with adrenal insufficiency can NOT rely on their body to do this for them therefore doctors have devised ‘steroid sick day rules’ where patients should increase their dose of steroid taken to help prevent adrenal crisis.

When should I increase my dose?

If you are unsure, please call 111 for advice

What is the NHS Steroid Emergency Card?

It is very important for you to always carry this card with you and to be familiar with its contents and sick day rules to prevent adrenal crisis. We recommend keeping this card in your purse/ wallet.

Where can I find further information?

Society for Endocrinology information leaflet on Steroid Sick Day Rules (enter this into internet search bar)

Versus Arthritis information leaflet on Steroids (available from www.versusarthritis.org)