Two readers with long personal experience of hydrocortisone replacement therapy feel that we did not get one important point right. We said that extra hydrocortisone was needed in conditions of mental and physical stress, and mentioned fever, severe trauma and anaesthesia. They would have said ‘moderate trauma’, and add that some patients need more with a bad head cold, prolonged strenuous exercise (eg skiing), unusual heat or cold, or an examination, and can be left seriously undertreated if the doses are not increased for a few days. They agree that it is unwise to increase doses for everyday stresses, but note that different stresses can be additive and that prolonged stress may need some adjustment of dose for a short period – perhaps up to a week. Inadequate replacement can cause headache, nausea, anxiety, lack of concentration and general malaise – not only hypotension and tachycardia.
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