Table 4.

Patients in whom new emergency steroid card should be given

Primary adrenal insufficiency	All causes. Commonest causes are Addison's disease, congenital adrenal hyperplasia, bilateral adrenalectomy and adrenal haemorrhage
Pituitary/hypothalamic disease	Patients with hypothalamo-pituitary dysfunction known to be steroid dependent Patients with hypothalamo-pituitary dysfunction advised to take steroids for intercurrent illness
Other causes	Exogenous steroids Prednisolone 5 mg/day or more Dexamethasone 0.5 mg/day or more Hydrocortisone 15 mg/day or more Inhaled steroids Fluticasone >500 mcg/day Beclomethasone >1000 mcg/day Nasal steroids > 1000mcg/day Drugs known to inhibit cortisol clearance (eg antifungals such as itraconazole, antiretroviral drugs) on exogenous steroid that may be stopped Repeated doses of exogenous steroids or where there are clinical concerns about AI

Primary adrenal insufficiency

All causes. Commonest causes are Addison's disease, congenital adrenal hyperplasia, bilateral adrenalectomy and adrenal haemorrhage

Pituitary/hypothalamic disease

Patients with hypothalamo-pituitary dysfunction known to be steroid dependent
Patients with hypothalamo-pituitary dysfunction advised to take steroids for intercurrent illness

Other causes

Exogenous steroids

Prednisolone 5 mg/day or more
Dexamethasone 0.5 mg/day or more
Hydrocortisone 15 mg/day or more

Inhaled steroids

Fluticasone >500 mcg/day
Beclomethasone >1000 mcg/day
Nasal steroids > 1000mcg/day

Drugs known to inhibit cortisol clearance (eg antifungals such as itraconazole, antiretroviral drugs) on exogenous steroid that may be stopped
Repeated doses of exogenous steroids or where there are clinical concerns about AI