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Stress-Dosed Glucocorticoids and Mineralocorticoids Before Intensive Endurance Exercise in Primary Adrenal Insufficiency

Bonnecaze, Alex K. MD*; Reynolds, Patrick MD; Burns, Cynthia A. MD*,‡

Clinical Journal of Sport Medicine: November 2019 - Volume 29 - Issue 6 - p e73–e75
doi: 10.1097/JSM.0000000000000540
Case Report
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Abstract: Patients with primary adrenal insufficiency (PAI) require increased doses of glucocorticoids and mineralocorticoids during stressors, such as surgery, trauma, and sepsis. Although current guidelines exist for dose adjustments in these situations, there is no accepted dosing regimen for patients with PAI participating in intensive endurance exercise. Given the extensive physiologic stress of events, such as marathons, triathlons, and similar events, it is likely that a “stress-dose” of adrenal replacement therapy will not only prevent adrenal crisis, but also improve performance. A 50-year-old male endurance athlete with known PAI reported severe fatigue, nausea, and malaise after competing in prior marathons and intensive endurance exercise. After supplementing with glucocorticoids and mineralocorticoids before competition, he experienced decreased symptoms and improved performance. To better care for these patients, further studies should be conducted to provide safe and effective glucocorticoid and mineralocorticoid dose adjustments before intensive endurance exercise.

Departments of *Internal Medicine;

Neurology; and

Endocrinology and Metabolism, Wake Forest University, Winston-Salem, NC.

Corresponding Author: Alex K. Bonnecaze, MD, Department of Internal Medicine, Wake Forest University School of Medicine, 1107 Irving St, Winston-Salem, NC 27103 (abonneca@wakehealth.edu).

The authors report no conflicts of interest.

Received February 21, 2017

Accepted September 14, 2017

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