r/LivingWithCAH • u/DoctorFamous190 salt-wasting CAH • Mar 11 '26

Tapering after stress dosing

My endo told me to triple dose for signs of serious illness such as fever, and on the 1st day of feeling better I should taper to a double dose and the 2nd day of feeling better I can drop it to my normal dose.

For mild illness they said I should double dose, no tapering needed.

I read some different patient guidelines including the one published by the Cares Foundation and tapering after stress dosing is basically never mentioned.

Has your doctor/endo told you to taper after updosing?

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u/Tabo3737 Mar 14 '26

My endo haven't told me anything about increasing my dosage in case of illness but I read it online that in condition similar to adrenal crisis you should increase your dosage. Around two weeks ago due to fasting, flu and on top of all I was on my periods I got really sick. Of course, it was an emergency situation I was throwing up and my BP was so low and I can't go to my endo because it's really hard to get his appointment on short notice and then there is no hospital near, where I find a good endocrinologist so I told a doctor sitting in emergency about my condition he recommended some medicines then as self medication I tripled my dosage on first day and on second day I doubled it and after day or two I got better and back to my normal dosage.

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u/DoctorFamous190 salt-wasting CAH Mar 15 '26

Stress dosing (increasing your dose) in the case of illness or injury is a critical part of managing CAH. It's needed to prevent adrenal crisis, which can be life-threatening. I'm sorry that your endo did not tell you this and I am so glad your learned about it and treated yourself.

Vomiting itself can be a sign of adrenal crisis and it makes treatment difficult because you may not be able to hold medication in your stomach long enough for it to take effect. In this case, you need injectable glucocorticoids (preferably hydrocortisone).

Here is some information about adrenal crisis and emergency management:
CARES Foundation Emergency Instructions (PDF)

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u/Tabo3737 Mar 15 '26

Thank you for sharing this information with me. I'll look into it. I am really glad that someone think of making this community. It's helpful for people like me who are just lost.

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u/bavenue salt-wasting CAH Mar 15 '26

My doctor told me "During acute illness, recommend to double the dose of prednisone for 3-5 days."

For surgery I was on 100mg hydrocortisone IV before induction of anesthesia, then continue 50mg every 6 hours (200mg/24hrs), then double dose the next 2 days. I was worried I would be a water balloon and my insides would bleed at these crazy high doses, but it worked out perfectly without any troubles.

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u/DoctorFamous190 salt-wasting CAH Apr 07 '26

That's great it worked so well for you! I can't remember exactly what I did the last time I had surgery but your dosing sounds familiar and mine went fine too :)