Table 4.

Patients in whom new emergency steroid card should be given

Primary adrenal insufficiencyAll causes. Commonest causes are Addison's disease, congenital adrenal hyperplasia, bilateral adrenalectomy and adrenal haemorrhage
Pituitary/hypothalamic diseasePatients with hypothalamo-pituitary dysfunction known to be steroid dependent
Patients with hypothalamo-pituitary dysfunction advised to take steroids for intercurrent illness
Other causesExogenous 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