Adrenal Insufficiency Stress Dosing Calculator

This calculator estimates supplemental ("stress dose") hydrocortisone for a patient with known adrenal insufficiency who needs extra glucocorticoid coverage during illness, surgery, or other physiological stress, since their adrenal glands cannot mount the normal cortisol surge on their own. It uses a three-tier framework drawn from the Endocrine Society's 2016 clinical practice guideline on primary adrenal insufficiency and widely used perioperative protocols: minor stress (dental work, mild febrile illness) simply doubles the patient's usual maintenance dose; moderate stress (moderate surgery, pneumonia, fracture) uses a 50 mg IV bolus followed by 25 mg every 8 hours; and major stress (major surgery, sepsis, trauma, critical illness) uses a 100 mg IV bolus followed by 50 mg every 8 hours. Stress level is generally the dominant factor at typical maintenance doses -- switching between minor, moderate, and major changes the recommended dose more than a modest adjustment to the patient's usual maintenance dose, because moderate and major stress use fixed institutional doses regardless of the patient's individual maintenance regimen. (At the extreme ends of the maintenance-dose range, the two effects can become comparable in size, since maintenance dose only directly scales the result at the minor-stress level.) Note that real protocols vary here: some use intermittent dosing (as modeled here, roughly 150 mg/day for major stress from 50 mg every 8 hours) while others use a continuous 200 mg/24h infusion or 50 mg every 6 hours for the same major-stress category -- both are used in practice and deliver a similar but not identical total daily dose.

The prednisone and dexamethasone equivalents shown are potency conversions for reference only, NOT a recommendation to substitute those drugs during acute stress dosing: hydrocortisone is specifically preferred in this setting because, unlike dexamethasone, it also provides mineralocorticoid activity at these doses, which matters for blood pressure and electrolyte stability during a stress response or adrenal crisis. This tool does not replace an individualized plan from the patient's endocrinologist or emergency stress-dose protocol.