What is adrenal insufficiency?
The adrenal gland is located on top of the kidney and makes three types of hormones. The main one is cortisol (which is a corticosteroid). Cortisol is a hormone that helps to maintain blood sugar levels and helps in metabolism of fat, protein and carbohydrates. Cortisol is especially important in times of stress.
In some children, the body cannot make enough cortisol. This is called adrenal insufficiency. The symptoms of adrenal insufficiency include fatigue, muscle weakness, decreased appetite and weight loss. Infants may not regain their birth weight and may have trouble feeding. Some children experience nausea, vomiting and diarrhea. In older children, symptoms can include dizziness, sweating, low blood sugar and low blood pressure.
What is hydrocortisone?
Hydrocortisone is a corticosteroid, a medication used to treat adrenal insufficiency, inflammation and other conditions. This document talks about the use of hydrocortisone for replacement therapy only.
How to get hydrocortisone suspension
The hydrocortisone suspension that your child requires is specially prepared by your pharmacist. Community pharmacists may obtain the recipe from the SickKids Pharmacy compounding website or by contacting the SickKids Shoppers Drug Mart (416-813-6700).
Please notify your pharmacy at least three days before you need refills so they have time to prepare this suspension.
How to store hydrocortisone suspension
The medication is stable for 60 days and should be stored at room temperature. It should be protected from direct sunlight in a cool cabinet.
You may ask the pharmacist to split the prescription into more than one bottle for day care or school as your child gets older.
How to give hydrocortisone (cortisol) suspension to your child
Supplies needed:
- Hydrocortisone suspension
- Oral syringe
- Warm water
Directions
- Before giving each dose, shake bottle well as the medication will settle to the bottom during storage.
- Using a syringe, draw up the prescribed dose.
- Slowly squirt medication into your child’s inner cheek. If your child uses a pacifier, place it in the mouth as this will help with swallowing the medication. DO NOT squirt to the back of the throat as this can cause your child to choke.
- Ideally, hydrocortisone should be given by itself. However, if your child does not tolerate the taste, it may be mixed into a very small amount (i.e., a spoonful) of soft food or milk. Do not mix with a bottle of milk or a bowl full of food in case your child does not finish the full portion. Hydrocortisone should not be given on an empty stomach as it can cause stomach upset.
- After giving the dose, clean syringe with warm water.
- Follow the scheduled dose times provided by your child’s health-care provider when giving the medication (e.g., 7:00 a.m. – 3:00 p.m. – 11:00 p.m.). Usually, being late or early by 30 to 60 minutes will not make a difference. It is important to give the medication regularly to avoid symptoms of adrenal insufficiency.
If your child vomits or has diarrhea within 30 minutes of taking the medication, you should immediately give the full dose again. If your child vomits or has diarrhea again after the repeated dose, they need to seek medical attention as they may require an injection of cortisol.
Any time your child needs an injection of cortisol, it is a medical emergency and they must be seen by a health-care professional at your nearest Emergency Department.
During times of illness, the oral dose of hydrocortisone may need to be increased. Your health-care provider will provide instructions on how to adjust the medication.
It is important to inform all caregivers about your child’s condition. Your child should always wear a Medical ID bracelet/necklace once they are able to do so.
Possible side effects of hydrocortisone suspension
Corticosteroids given at very high doses can lead to side effects such as:
- increased risk of infection
- raised blood sugar
- increased weight gain
However, at doses given for adrenal insufficiency, these symptoms should not occur as the dose is replacing what the body normally makes.
For more information about possible side effects, please see Corticosteroids given for a long time.
