Endocrine Abstracts

Patients with Addison’s or adrenal insufficiency require regular steroid replacement usually in the form of oral hydrocortisone. Standard advice is given on how to deal with intercurrent illness and special situations such as surgery. Organisations such as the Addison’s disease self-help group provide authoritative guidelines for patients. Several of our patients with adrenal insufficiency have asked how their steroid replacement treatment should be adjusted for expeditions that take them up high mountains or to altitudes above 1500 m. We did not identify any pre-existing patient information resources about this situation and so we developed one.

Method: We reviewed the published literature on glucocorticoid and mineralocorticoid replacement at high altitude. We adapted the principles learned from this to make a simple and practical patient information guide. We used this to advise our patients on how to handle their steroid replacement while at altitude. We also asked them to provide us with feedback about their own experiences so that the resource can be improved by an iterative method.

Results: The key principles of steroid replacement at altitude are these

1. On the day of travel to altitude (>1500 m) switch to a double dose of hydrocortisone.

2. Remain on the higher dose for 48 hours to acclimatize and then go back to your normal dose.

3. If, during your travels, there is further significant (>400 m) increase in altitude then we recommend you go back to the double dose of hydrocortisone for another 48 hours.

4. The requirements for fludrocortisone do not increase at altitude.

The patient information resource on steroid replacement at altitude is currently being tested and improved by our patients, allowing them to minimise the risk of Addisonian crisis whilst they seek adventure at altitude.