During times of stress or infection, what should be done regarding glucocorticoid therapy in Addison's disease?

• A. Decrease the dose.
• B. Increase the dose.
• C. No change.
• D. Discontinue the medication.

Answer: (B)

During times of stress or infection, the body's need for cortisol rises. In Addison's disease the adrenal glands can't increase cortisol production, so the usual glucocorticoid replacement must be increased to meet this higher demand and prevent adrenal crisis. Practically, this means temporarily raising the dose of glucocorticoid therapy—often by about two to three times the usual amount or as directed by the clinician. If oral dosing isn’t possible due to vomiting or severe illness, use injectable hydrocortisone and seek medical care promptly. After the illness passes, resume the usual replacement dose and inform the healthcare provider about the episode to adjust future sick-day plans.