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Hydrocortisone replacement


Proforma for hydrocortisone replacement during pituitary surgery
Hydrocortisone replacement patient information sheet

Recommendations for changes in hydrocortisone regimen
If a patient is unwell they should take additional hydrocortisone. The amount depends on how unwell they are and the type of illness. Some examples:


 Increase in dose



Cold without fever 




Fever, flu, infection        

double dose    

duration of illness

see GP after 48 hours

Vomiting > once, diarrhoea and severe illness

Emergency 100mg injection if extra dose of 10-20mg cannot be kept down

restart usual dose once stable

Phone GP or go to A&E. Administer injection prior to this if emergency pack available (but still seek help)

Minor surgical procedure e.g. tooth extraction    

20mg hydrocortisone before procedure

resume on usual dose immediately afterward


Minor operation e.g. hernia repair 

100mg im every 6 hours for 24 hours 

 resume on usual dose immediately afterward


Major operation e.g. abdomen or chest

100mg im injection every 6 hours for 24 -72 hours and eating and drinking

reduce rapidly to usual dose

tell the surgeon and anaesthetist before the operation

Pituitary surgery     

see proforma 

see proforma 



Double the dose the day before during bowel prep. For colonoscopy 100mg im before procedure

take usual dose on the morning of the procedure

drink lots of water to prevent dehydration. Inform your doctor.


Double dose on the day of procedure.

resume as normal        

inform your doctor.

Severe shock e.g. bereavment or road traffic accident

20mg as tablet or 100mg intramuscular injection

See GP or hospital for further advice

Sudden and severe shock may be classed as an emergency - seek advice

Long haul flight > 12 hours

double dose on the day of the flight

extra dose every 6-8 hours when the day is legnthened. Usual regimen in timing with sleep / wake cycle when day is shortened.

Speak to your consultant before travel.*

General stress, exams etc

 not usually required


ask GP if concerned 

* Travel
Patients should travel with a 100mg injection kit  in case of emergency. They should be provided with a letter stating that they need to keep this with them to satisfy security.