Training for marathons and other endurance events for patients with adrenal insufficiency


For those patients who are taking part in marathon events, we provide general guidance to help you keep safe and well whilst running.

Running Treadmills


During long, slow training it is advised to keep to your usual daily doses of hydrocortisone (or prednisolone), but you can take an extra hydrocortisone 5mg (or 1-2mg prednisolone) after you have been running for an hour to ninety minutes. It is important to keep well-hydrated and have access to fluids during training.

If this is one of your first attempts as a post-diagnosis return to fitness, you might feel the need to take a little more steroid during early training and events. Therefore, an extra 10mg pre-training and if felt needed, an extra 5mg, at the end of your training session should be sufficient. This should be short term, until your body becomes accustomed to training and running distances.

Overall, as long as fitness is built slowly, and training is completely ‘aerobic’ there should be little need for extra hydrocortisone or prednisolone above these amounts. Some patients find that they need the extra small doses, even in training, and it is important to ‘listen to your body’ and also discuss any issues with your endocrinologist.


Marathon day

On race day, most marathoners should have a fluid and ‘refuelling’ strategy and a suggested regime is to take an additional hydrocortisone 5mg at the start of the race and 5mg when you ‘refuel’. There should be no need to increase your hydrocortisone on the day before the race. 

Again, fluids will be accessible at points along the course, ensure your hydration is optimum before you start and you remain as hydrated as possible throughout the run – to hydrate efficiently, don’t gulp fluids but sip regularly. There will be no harm on the day by taking a little extra hydrocortisone.


‘Hitting the wall!’

Information from the London Marathon (this should be similar guidance at all marathons):

When you’ve got your runner number, please fill in the medical information section on the back. Be careful not to damage or lose your number as replacements can’t be issued. If there’s a risk you may blackout during the race (for example if you suffer from fits), please put a red cross on the front of your number. This can apply to those with adrenal insufficiency and it needs to be clearly seen by the race marshals.  Carry hydrocortisone tablets with you and if you feel you are ‘hitting the wall’, you can take 5mg or 10mg quickly.  St John Ambulance will again be looking after first aid at the marathon and will have the following available on the day:

  • 1400 medical, nursing and first aid volunteers
  • 50 specialist crewed ambulances
  • 30 cycle response units (first aiders on bicycles who can weave in and out of crowds easily)
  • 1500 rehydration sachets for dehydration.

Plan and know where first aid points are along your route. Keep safe and good luck!


July 2015