Can You Continue Hydrocortisone During Your Stress Test?
Yes, you must absolutely continue taking your hydrocortisone on the day before and the day of your stress test—stopping this medication could trigger a life-threatening adrenal crisis. 1, 2
Critical Safety Principle
Your hydrocortisone is not a medication that can be safely stopped for testing purposes. Unlike many cardiac medications that are held before stress tests, hydrocortisone is essential hormone replacement therapy for your severe adrenal insufficiency. The FDA labeling explicitly warns that "in any situation of stress occurring during that period, hormone therapy should be reinstituted" and emphasizes that drug-induced secondary adrenocortical insufficiency requires careful management. 2
Why This Matters for Your Stress Test
- Physical stress from the test itself: A cardiac stress test represents a significant physical stressor that actually increases your body's cortisol requirements 1, 3
- Risk of adrenal crisis: Stopping your hydrocortisone before a stressful procedure could precipitate acute adrenal insufficiency, which is potentially lethal if not immediately treated 4, 5
- Standard protocol: Guidelines specifically recommend endocrine consultation prior to any procedure for stress-dose planning, recognizing that patients with adrenal insufficiency need more, not less, glucocorticoid coverage during procedures 6
What You Should Do
Take your regular doses (15 mg morning, 5 mg afternoon) on both the day before and the morning of your test 7, 1:
- Take your 15 mg dose upon awakening on the day of the test 7
- Your afternoon 5 mg dose should be taken in early afternoon (around 2 PM) if your test schedule permits 7
- Consider taking an extra morning dose 1 hour prior to the procedure if your physician recommends it 1
Contact Your Ordering Physician Immediately
You need to clarify this instruction with the physician who ordered your stress test. The instruction to stop "all medications" 24 hours before the test was likely intended for cardiac medications (like beta-blockers or calcium channel blockers that can affect heart rate response) and should never apply to essential hormone replacement therapy like hydrocortisone. 2
When you call, specifically mention:
- You have severe adrenal insufficiency requiring daily hydrocortisone replacement
- You take 15 mg morning and 5 mg afternoon
- You need confirmation that you should continue this medication (and likely need stress-dose coverage)
Common Pitfall to Avoid
The most dangerous mistake would be following a blanket "stop all medications" instruction without clarifying that your hydrocortisone is life-sustaining hormone replacement, not an optional medication. Patients on corticosteroids for adrenal insufficiency need education on stress dosing and should never abruptly discontinue therapy. 6, 4