Hydrocortisone replacement for pituitary patients

Your doctor has decided that you should be on steroid replacement with a tablet called hydrocortisone until further notice. This is because you have a condition, or have undergone treatment, that may have affected the working of the pituitary gland, which controls the production of cortisol in the body. The aim of this leaflet is to explain how to take this medication and the rules to follow in times of illness.

What do my tablets do?

Hydrocortisone is one of a group of medicines called corticosteroids (steroids for short). It is the medicine most commonly used to replace cortisol, a hormone essential for life. Abnormalities of the pituitary gland (or of important structures nearby) can lead to a lack of cortisol. In these circumstances, it is very important to correct this deficiency.

At no stage should these tablets be stopped without consulting your doctor first – to do so may be life-threatening.

How do I take my tablets and what dose should I be on?

Ideally for those on long-term replacement, hydrocortisone tablets should be taken three times a day in order to mimic the body’s normal pattern of steroid production. In these circumstances the total daily dose (eg 20mg) is typically divided so that 10mg is taken in the morning shortly after waking, 5mg at lunchtime, and 5mg at teatime (16:00 to 18:00). If this final dose is taken later in the evening, then you may experience difficulty with sleeping.

Following pituitary surgery you may be on 10mg hydrocortisone in the morning and 5mg at lunchtime. (15mg in total).

Some individuals require slightly higher daily doses (eg 30 to 40mg / day) often due to interactions with other medicines. This will all be discussed with you before your discharge home.

Can I take other medicines whilst taking steroids?

Yes, but you must always tell your doctor which other medicines you are taking. Before taking any over the counter medicines, you should discuss with the pharmacist to ensure that these will not interfere with your steroid tablets.

Can I drink alcohol while I am on steroids?

Yes, you may drink alcohol in moderate quantities.

How long should I continue taking my tablets for?

Your endocrinologist will discuss the possible timing for stopping your tablets only if it is considered safe to do so, following blood testing. Some patients will need to take steroids for life. Remember, you must not stop taking your tablets without consulting your doctor first.

What do I do if I miss a dose?

If you forget to take a dose, then take it as soon as you remember. However, do not take two doses at the same time unless you feel unwell (see below). If you have taken more than the prescribed dose, contact your doctor for advice.

What do I do if I become ill?

For minor illness such as coughs and colds you may not require any extra steroid. However, if you feel unwell (symptoms of steroid deficiency may include weakness, tiredness, nausea/vomiting, abdominal pain and dizziness), or for example have flu or an infection then you should double your dose of hydrocortisone until you feel better. If the illness continues for more than a week you should consult your doctor. Hydrocortisone is absorbed rapidly by the stomach, so a slight stomach upset may only require you to double your dose or re-take a dose if you vomit shortly after taking the tablets. However, if you are unable to keep the tablets down due to vomiting and / or diarrhoea, then you will need to have an injection of hydrocortisone and must seek medical advice without delay.

You (or a relative or close friend) may have been taught how to administer a hydrocortisone injection, should you be involved in a major accident or emergency situation, such as breaking a limb. However, remember that you will still need to seek medical advice following the injection.

If at any time you are unsure what to do regarding your steroid dose, please contact your GP or the hospital for advice.

What happens if I need to undergo surgery or dental work?

For minor surgery or dental treatment (e.g. filling / extraction with local anaesthetic) a small top up of around 10mg to 20mg just before the procedure is advised.

For major dental work or surgery (e.g. extraction with general anaesthetic) or investigations such as endoscopy, it is important that you receive additional hydrocortisone cover by injection before, and in some cases for several days after, the procedure. Please discuss this with your doctor / dentist well in advance of the procedure. If they are unsure of the management of your hydrocortisone cover they should contact your endocrinologist or the endocrine nurses on 01223 217848.

What side effects might I experience?

As you are taking steroid tablets to replace the natural hormone that your body makes, you should experience few side effects. Occasional complaints are:

Ankle swelling, increased appetite and heartburn / indigestion which is often helped by taking your tablets with food.

I have recently had an operation on my pituitary gland, how long will I need to stay on the tablets for?

Following pituitary surgery you will be prescribed a replacement dose of hydrocortisone which you must continue to take until your clinic appointment with your endocrine doctor, eight weeks after surgery. At six weeks following surgery you will be asked to attend the endocrine investigation unit in Addenbrooke’s Hospital for your post-op testing. On the morning of your appointment we will ask you to omit your dose of hydrocortisone until after the blood tests have been done. However, you should bring your hydrocortisone tablets with you to this appointment to take once testing is completed.

If you have been referred to the neurosurgical team at Addenbrooke’s by a physician from a different hospital, then it is possible that hormone testing and endocrine follow up after surgery will be undertaken back at your referring hospital.

Important!

You must not drive without having taken your steroid replacement medication.

It is strongly recommended that those on long term steroid replacement therapy wear a Medic Alert bracelet at all times, which identifies that you require additional steroid treatment in the event of an emergency.

Storing your medicine

Always keep your medicine out of reach of children. Store your tablets in a cool, dry place in the bottle in which they were given to you. Return unused or old tablets to your pharmacist for safe disposal. If you have any further questions consult your doctor or pharmacist.

Contact information

Addenbrooke’s endocrinology team: Telephone 01223 217848