Cortisol Deficiency

What is Cortisol?

CORTISOL (also known as hydrocortisone) is a hormone produced by the adrenal glands. Cortisol is necessary for daily functions. During times of stress (such as during illness, surgery and accidents) normal adrenal glands produce extra amounts of cortisol, which helps the body recover from stress. There are many forms of cortisol that are made synthetically. Some of these forms include: Cortef, Hydrocortisone, Solucortef, Cortisone, Prednisone, Decadron, Medrol, etc. Although they are all derivatives of cortisol, they all differ in their potency (how strong they are).

What is cortisol defiency?

CORTISOL DEFICIENCY can occur in several disorders, including congenital adrenal hyperplasia, pituitary gland malfunction, malformations of the adrenal glands, Addison’s disease or after stopping cortisone (Cortef, Prednisone, Decadron, Medrol, etc) treatment. Your child has been diagnosed with cortisol deficiency which is due to HYPOPITUITARISM. Because of this deficiency, your child may need extra amounts of cortisol in order to recover from major stressful events. This extra amount of cortisol can usually be given by increasing amounts of the pill or liquid form of cortisol which your child takes every day. Usually, one triples the dose of cortisol. In some cases, however, children with cortisol deficiency are too sick to take medicines by mouth and must receive the extra cortisol by injection. The instructions below describe what you should do if your child needs extra cortisol.

Your child should always wear an identification bracelet or necklace with the words “Hypopituitarism” “Cortisol Deficiency” or “Adrenal Insufficiency”, “takes Cortef”, or a similar statement. This is to inform medical personnel that your child needs extra cortisol during stresses such as accidents or sudden illnesses. You may not be immediately available or you may be unable to speak for your child during these events. A wallet ID is NOT adequate since this can be misplaced during an emergency.

For minor illness or stress


If your child is scheduled for any surgical procedure (including dental surgery), please have the surgeon, dentist, or anesthesiologist call us (303) 783-3883 for advice regarding the cortisol dose.

For MINOR illness or stress, such as: colds, mild “flu” or other illness with minimal fever, ankle sprains, or minor injuries:

Double each dose of cortisol (hydrocortisone, Cortef). For instance, if your child’s usual dose is one pill 3 times a day, increase this to two pills, 3 times a day. If your child is on cortisol only once or twice a day, give 2 times the usual amount once or twice day. During these illnesses, you should call our office (783-3883) so that we can give you advice on how long to continue with the higher cortisol dose. You should always contact us or your family physician as soon as possible if your child has an illness with vomiting. Extra amounts of salt may also be necessary during these illnesses, especially if your child is an infant. Consult your physician for further advice.

After your child has recovered from the minor illness or injury, the dose of cortisol can be decreased to the usual amount. In most cases, your child will not require the increased dose of cortisol for more than 2 or 3 days.

For major illness

For MORE MAJOR illnesses, associated with a fever over 101 degrees and/or vomiting/diarrhea:
Triple each dose of cortisol (hydrocortisone, Cortef).

For MAJOR illness or stress, such as: severe dehydration; unconsciousness; illnesses with continuous vomiting or diarrhea; accidents with multiple broken bones, internal injuries or unconsciousness:
CALL your physician or take your child to the NEAREST hospital IMMEDIATELY. If this is not possible, or there is a delay, give your child an intramuscular injection of cortisol as follows:

  2. Twist the rubber top on the Solu-Cortef 250 mg/2cc Mix-O-Vial so that the liquid enters the powder section.
  3. Mix gently by shaking or rolling until the mixture is clear.
  4. Clean the rubber stopper with alcohol or water.
  5. Stick the needle through the rubber stopper. Then turn the bottle upside-down (with the needle still in it) and draw up ________ cc of the cortisol into the syringe.
  6. Inject into a muscular part of the body, such as the thigh or upper arm. If possible, clean the injection site first.

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