Guidelines for the Child
Who Is Cortisol or Steroid Dependent
This handout is to help you learn about
cortisol dependency and its treatment. It
also covers safety measures to follow at
home. If you have any questions, please ask
your nurse or doctor.
What does "cortisol dependent" mean?
Cortisol is a hormone made by the adrenal
glands. It keeps the body’s blood pressure
and blood sugar from dropping too low. It
helps the body deal with physical stress.
Cortisol dependent means that the adrenal
glands cannot make enough (or any) cortisol.
Your child must take medicine to replace it.
What is the treatment?
Hydrocortisone is used to replace cortisol.
You may also hear your doctors and nurses
call this Cortef®. It is taken by mouth 2 – 3
times each day to maintain the level of
cortisol in your child’s body. Sometimes it
may need to be injected. If your child has
asthma or certain illnesses, other medicine is
What should you know about stress and
the need for extra hydrocortisone?
In times of stress, your child must receive
extra hydrocortisone. Your doctor and
nurse will fully explain why this is needed.
If your child does not receive the extra
hydrocortisone, acute adrenal insufficiency
may result. If not treated, this can lead to
loss of consciousness, coma, or even death.
Physical stress in this case is defined as
fever, surgery, serious injury, or significant
illness that your child may have. When the
body is under stress, the adrenal glands
should make extra amounts of cortisol.
Because your child’s glands do not make the
extra amount needed, your child needs extra
What are the sick day guidelines for your
Extra hydrocortisone must be given during
times of extreme physical stress such as
fever or trauma. Your child’s stress dosing
If your child has an illness, fever greater
than 100.5°F or a minor injury or sprain,
then you should give your child ________
mg of hydrocortisone, by mouth, every 8
For any of these situations, you will need
to give your child the injectable medicine.
ξ Your child vomits and cannot take
anything by mouth. This would
include your child vomiting the oral
dose within 30 minutes of taking it.
ξ Your child “looks bad” (pale,
sweaty, breathing fast, very tired, not
responding), has a serious injury
such as a broken bone, or loses
consciousness, inject the medicine as
ordered and call 911.
Your child’s injectable dose will be _______
mg of _____________________.
What other points should you think about?
ξ It is a good idea to ask about sick day
guidelines during your child’s
routine visits so you can be ready for
ξ When your child is ill, make sure
to give extra fluids to prevent
ξ If you child needs surgery, major
dental work, or has been in an
accident, large doses of
hydrocortisone will often be
needed. Tell the doctor or dentist
that your child has cortisol
deficiency before any procedure.
ξ For children under 2 years old
you should stress dose your
child on the days they will be
receiving immunizations or
vaccinations. For all children
stress dosing is required if they
have a fever in the days
ξ As a rule, emotional stress does
not require increased
ξ It is helpful for you to review this
Health Facts each month so that you
will know how to follow the
guidelines if your child becomes ill.
At that time, you can also check the
expiration date on the injectable
medicine. You can be certain you
have the syringes and needles that
you need. Families tell us that
reminders on their calendars have
helped them to remember.
Your child must wear a medical
identification bracelet or necklace to alert
people in times of emergency that your child
has a cortisol deficiency and is taking
Endocrine Clinic, Monday to Friday,
8:00am to 4:30pm (608) 263-6420
Nights, weekends, & holidays:
Call (608) 263-6420. This will give you the
paging operator. Ask for the pediatric
endocrine doctor on-call. Leave your name,
and phone number with the area code. The
doctor will return your call.
If you live out of the area, please call:
The Spanish version of this Health Facts for You is #6539
Your health care team may have given you this information as part of your care. If so, please use it and call if you have
any questions. If this information was not given to you as part of your care, please check with your doctor. This is not
medical advice. This is not to be used for diagnosis or treatment of any medical condition. Because each person’s health
needs are different, you should talk with your doctor or others on your health care team when using this information. If
you have an emergency, please call 911.Copyright © 7/2016 University of Wisconsin Hospitals & Clinics Authority, All
Rights Reserved. Produced by the Department of Nursing HF#4424.