2026
Written by Paul Margulies, MD, FACE, FACP, Medical Director, NADF. Retired Clinical Associate Professor of Medicine, Zucker School of Medicine at Hofstra/Northwell.
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Q&A from NADF NEWS® March 2026
Q: Could you please forward current advice concerning cataract surgery for individuals with AI. Is a prior injection of cortisone needed? Or are pills alone sufficient and should dose be doubled or tripled?
A: Cataract surgery is a fairly minor stress. I usually recommend simply a mild extra oral dose of hydrocortisone 20 mg just before the procedure. However, it is very important to discuss the adrenal insufficiency diagnosis with the surgeon. It is common to have an anesthetist or anesthesiologist providing low dose sedation. They should be prepared to have injectable hydrocortisone available for the rare emergency for any complication.
Q: Can adrenal insufficiency cause multiple PVCs throughout the day?
A: Premature ventricular contractions, or PVCs are common, but not usually associated with adrenal insufficiency. During an adrenal crisis, with blood pressure falling, it is common to have sinus tachycardia, or simply a rapid heart beat, but that is not the same as PVCs. I suggest a cardiology evaluation.
Q: After eliminating steroids for 24 hours for a 6:30am blood test, do I need to stress dose afterwards or continue with my normal am dose?
A: After the blood is drawn, just resume the normal am dose unless you have any significant adrenal insufficiency symptoms.
Q&A from NADF NEWS® June 2026
Coming soon!
Questions from Social media
Q: Can long term steroid use cause brain fog or forgetfulness?
A: Many factors can contribute to memory issues, including stress. Maintenance doses of glucocorticoids to manage adrenal insufficiency should not cause it.
Q: If an Addisonian goes into anaphylaxis causing an adrenal crisis, what injection should be administered first?
A: Epi-pen, then Solu-Cortef.
Q: Should someone with Addison’s get multiple vaccines in a day?
A: Try to take no more than two at a time. For example, get the covid vaccine, then flu and RSV a week or two later.
Q: Does taking hydrocortisone affect my cholesterol?
A: Normal replacement doses of steroids do not elevate cholesterol. Transient need for stress doses may cause a temporary elevation, but it will resolve when normal doses resume.
The prolonged use of high doses, usually for management of inflammatory diseases like asthma or rheumatoid arthritis, will significantly increase cholesterol and blood sugar. In that situation, medication for the cholesterol and blood sugar elevations become necessary. It is never appropriate to reduce steroid doses just to lower cholesterol.
Q: What vitamins should you avoid with Addison’s?
A: There is no specific vitamin that is harmful to those with Addison’s. Many vitamin supplements are overused, with limited evidence for any benefit. Eating a healthy diet is much more important than any vitamin.
Q: Is green tea bad for those with Addison’s?
A: In normal quantities, green tea is safe and causes no specific issues to an Addisonian. Enjoy your green tea!
Q: Can Addison’s cause diabetes?
A: No. It doesn’t cause diabetes. Type 1 diabetes is more common in people with Addison’s. Type 2 diabetes is common overall and may occur with age, weight, or high steroid doses.
Q: Should an Addisonian updose with hydrocortisone before a tattoo?
A: If needed, 5–10 MG should be enough to cover the stress from the pain. If you have a high pain tolerance, you may not need any extra.
Q: When should parents give stress dose steroids to their child?
A: Children who rely on daily oral hydrocortisone replacement often need additional oral hydrocortisone to mimic the body’s natural stress response. Stress-dose hydrocortisone may be needed during illness, physical stress, in emergencies or before surgery. For more details, see NADF's info on stress dosing for children.
Q: Can people with adrenal insufficiency live a long and fulfilling life?
A: People with adrenal insufficiency can live long and fulfilling lives! Outcomes may depend on the specific condition and other health issues. Most importantly, it’s essential to take daily replacement medications as prescribed, increase doses during illness or stress (including before surgery), and maintain a healthy lifestyle overall.
Q: Why is it important to take your corticosteroids every day?
A: Corticosteroids mobilize nutrients, modify the body’s response to inflammation, stimulate the liver to raise the blood sugar, and help to control the amount of water in the body. Oral corticosteroids do not stay active for more than a day. Hydrocortisone only last for hours. Corticosteroids aren’t optional for adrenal insufficiency — they replace what the body can’t produce and keep all systems running smoothly.
Q: How do you know when you have found the right endocrinologist who will advocate for you?
A: If available, try to find an endocrinologist who specializes in adrenal health. Be open about your symptoms during your visit — your doctor should listen, acknowledge your concerns, and work with you to create a daily medication plan and appropriate lab schedule. If you find a great endocrinologist, let NADF know so we can add them to our map of Patient-Recommended Doctors.
Q: Can those with Addison’s use steroid eye drops? (I’ve previously been told you can’t, but I’m having bad allergies affecting my eyes.)
A: Steroid eye drops can be used by people with adrenal insufficiency and have the same effect as in other individuals. The steroids work locally in the eye, with very little systemic effect. There is no reason to alter the usual steroid maintenance dosage. As with any other prescription medication, it is important to discuss the frequency, dosage and length of treatment with your doctor.