We provide guidance on prevention of adrenal crisis during the global COVID-19 crisis, which exposes patients with adrenal insufficiency to an increased risk of acute COVID-19 infection while at the same time restricting access to healthcare due to capacity issues. We highlight the need for education (sick day rules, stringent social distancing rules), equipment (sufficient glucocorticoid supplies, steroid emergency self-injection kit) and empowerment (steroid emergency card, COVID-19 guidelines) to prevent adrenal crises. In patients with adrenal insufficiency developing an acute COVID-19 infection, which frequently presents with continuous high fever, we suggest oral stress dose cover with 20mg hydrocortisone every six hours. We also comment on suggested dosing for patients who usually take modified release hydrocortisone or prednisolone. In patients with clinical insufficiency showing clinical deterioration during an acute COVID-19 infection, we advise immediate (self-)injection of 100mg hydrocortisone intramuscularly, followed by continuous intravenous infusion of 200mg hydrocortisone per 24 hours, or until this can be established, administration of 50mg hydrocortisone every 6 hours.
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