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aaa INFORMATION FOR GENERAL MEDICAL AND SURGICAL WARDS Hydrocortisone Emergency in Pituitary Patients
Pituitary conditions are considered rare; general medical and surgical ward staff may only ever see one or two patients with this condition, or simply be unaware of hydrocortisone for pituitary conditions. Hydrocortisone is a steroid produced by the adrenal gland. A good majority of people with pituitary disease have to take replacement hydrocortisone daily, as they don’t produce this naturally. Therefore, as they take replacements, they don’t have the natural surge of Cortisol if they become acutely ill, are vomiting or have severe shock. Surgery protocol
Pituitary patients taking hydrocortisone, who are having planned or emergency surgery will require sufficient and increased cover of hydrocortisone depending on the type of surgery: SURGICAL PROCEDURES | | Minor (e.g. tooth extraction)
20mg before procedure | Resume on usual dose immediately after | Small (e.g. hernia)
100mg injection every 6 hours for 24 hours | Resume on usual dose immediately after | Major (e.g. addomen/chest)
100mg injection OR i.v. every 6 hours for 72 hours, or at least until patient is adequately eating & drinking (any doubt, continue for 72 hours) | Reduce rapidly to usual dose | COLONOSCOPY & BARIUM ENEMA | | Double usual dose the day before the bowel is cleared out | Take usual dose on morning of the procedure | For colonoscopy only: 100mg injection to be given by doctor 30 minutes before the procedure | Double usual dose on the following day | CYSTOSCOPY | | Double usual dose on the day of the procedure | Resume as normal |
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Further, the patient will have been given the appropriate replacement dose and times in the day, by their Endocrinologist, to take their hydrocortisone. It is important that patients manage their own ‘replacement dose’ once stable on your ward. It is important the patient’s normal daily dose and timings are not altered during the patient’s hospital stay. Please talk to the patient about their normal dosing, or, if you have concerns, contact the patient’s regular endocrine consultant. If you have any queries, or the patient is unwell, please contact the on call endocrinologist, or on call consultant physician without delay. REMEMBER PITUITARY PATIENT? > TAKING HYDROCORTISONE?> ADRENAL CRISIS?
IF YES - INJECT WITH HYDROCORTISONE
For more useful information about the Pituitary gland, pituitary disorders, resources available and The Pituitary Foundation, please use the following links:Please click here for a general guide to the Pituitary Gland
This page will provide a general overview of the pituitary gland and pituitary disease. Please click here to read the GP FactFile online.
The Foundation worked with endocrinologists across the UK to develop the GP Factfile, which provides more information about the pituitary gland and disorders of the gland presented in a format for the medical reader. Please click here to go to our booklets online.
The Pituitary Foundation offers a library of patient education booklets with titles covering the various conditions, treatments and lifestyle and well-being issues. These are all available to read online or download from our website. Please click here to learn more about the services provided by The Pituitary Foundation. Please click here for Links to Online Resources.
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Last Updated ( Friday, 23 December 2011 )
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General Medical or Ward Staff Information 
