Adrenal disorders and long-term corticosteroids: Addison, Cushing, crisis signs and steroid teaching
- Safe practice
The nurse watches glucose, blood pressure, infection and mood in patients on steroids, and knows that stopping them suddenly can cause a crisis.
What it is
Long-term corticosteroids and an excess of cortisol (Cushing syndrome) cause high glucose, weight gain with a round face and fat on the upper back, thin skin that bruises easily, poor wound healing, bone loss, infections that are hard to notice and mood changes. Long-term steroids also suppress the body's own adrenal hormones, so they are never stopped suddenly: they are tapered as ordered. In adrenal insufficiency (Addison disease) the body lacks cortisol, and often aldosterone, with low glucose and low sodium. An adrenal crisis is a life-threatening emergency with severe weakness, vomiting, abdominal pain, low blood pressure, low glucose and confusion. It can follow stopping steroids, an infection or another physical stress, and is treated at once with IV or IM hydrocortisone and fluids.
What it requires
- Monitoring on long-term steroids: weight, blood pressure, glucose, blood count and lipids; bone density at baseline.
- Some steroids with mineralocorticoid effect cause potassium loss, oedema and high blood pressure.
- After stopping long-term steroids, the stress response can stay impaired for months.
- Addison disease: low glucose and low sodium; Cushing syndrome: high glucose, round face, fat on the upper back, weight gain.
How it is applied (and why)
- Reconcile every steroid the patient takes or stopped recently: after a long course the stress response can stay impaired for months.
- Give steroid doses on time and never skip them without an order: missing doses can cause a crisis.
- Check glucose as ordered and report a rise or a fall when the steroid dose changes: insulin needs follow the steroid.
- Measure blood pressure and weight and look for oedema: fluid retention and high blood pressure are frequent effects.
- Look for subtle signs of infection, check the skin and wounds, and protect thin skin when moving the patient.
- Ask about sleep, mood and behaviour: steroids can cause insomnia, euphoria, mood swings or depression.
- Report vomiting or inability to take the oral steroid: the patient needs another route as the doctor decides.
- Before surgery or during a severe illness, remind the team about long-term steroid use: an extra dose may be needed.
- Teach: do not stop the steroid suddenly, report signs of infection, swelling or weight gain, carry identification and follow the sick-day plan.
In nursing practice
- Weakness, tiredness, nausea, abdominal pain, low blood pressure and low glucose after stopping steroids suggest adrenal insufficiency.
- A patient on long-term steroids with a new infection may have no fever: changes in mental status or breathing matter.
- Bone protection (activity, calcium and vitamin D, medicines) is planned for people at high risk of fracture.
- Children on long-term steroids can have slowed growth.
Common mistakes
- Stopping a long-term steroid because the patient is fasting or «doing well» without an order to taper.
- Not checking glucose in a patient without diabetes who starts high-dose steroids.
- Waiting for a fever to suspect infection in a patient on steroids.
- Mistaking an adrenal crisis for simple gastroenteritis: vomiting with low blood pressure in a patient on steroids or with Addison disease is an emergency.
Test yourself
Think of the answer, then tap the question to see it.
Why are long-term corticosteroids never stopped suddenly?
They suppress the body's own adrenal hormones. A sudden stop can cause adrenal insufficiency or a crisis, so the dose is tapered as ordered.
What are the signs of an adrenal crisis?
Severe weakness, vomiting, abdominal pain, low blood pressure, low glucose, fast heart rate and confusion that can progress to shock.
What effect do steroids have on blood glucose in hospital?
They raise it, mostly in the afternoon and evening. When the steroid dose falls, the insulin need falls too, so glucose is checked and changes are reported.
What should a person with adrenal insufficiency do if they cannot take their tablets because of vomiting?
Contact the care team at once or go to the emergency department, following the sick-day plan; vomiting can lead to an adrenal crisis.
Elsewhere in DurgiPedia
Connections
In Pharmacology2
Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.
Sources: Nursing Pharmacology, 9.3: Corticosteroids (Open RN, Wisconsin Technical College System (CC BY 4.0), LibreTexts, 2023); Acute adrenal crisis (MedlinePlus Medical Encyclopedia, U.S. National Library of Medicine, 2025); 16. Diabetes Care in the Hospital: Standards of Care in Diabetes—2025 (American Diabetes Association Professional Practice Committee, Diabetes Care (PMC), 2025).
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