Question: I am on permanent replacement steroids. Do I need to increase my dose with exercise? 

Answer: Some patients remain on permanent replacement with glucocorticoid steroids because the pituitary gland is not able to produce enough ACTH (following extensive pituitary surgery for Cushing’s disease or other pituitary tumor or disease); others are on permanent replacement with cortisol and fludrocortisone because both adrenal glands have been destroyed by an illness such as Addison’s disease (antibodies against the adrenal cortex) or surgically removed due to bilateral adrenal tumors or persistent Cushing’s disease.

As mentioned in the preceding answer, adequate replacement of cortisol is usually accomplished by taking normal doses of between 20-30 mg of cortisol per day in split doses. However people show different sensitivities to cortisol, so the individual dose required varies from person to person.

Normally, the body is able to adjust production of cortisol to help combat stress. Depending on the intensity of exercise, it may be necessary to take extra hydrocortisone such as 5 to 10 mg on days of strenuous exercise, for example high intensity tennis or long distance bicycle riding; the extra hydrocortisone is taken an hour or two before the exercise . This is best evaluated by comparing the capacity to complete the exercise with and without a supplemental dose. One should avoid taking extra cortisol when not really necessary, because frequent excess cortisol intake will create the deleterious effects resulting in Cushing’s syndrome. Usually, mild exercise does not require taking supplements of cortisol above the normal replacement.

An adequate adaptation of hydrocortisone intake to allow good quality exercise is an overall excellent way to maintain good health.

By Dr. André Lacroix, Spring, 2015