What is the dental management consideration for a patient with Addison disease scheduled for a stressful dental procedure?

Patients with Addison disease (adrenal insufficiency) are unable to produce adequate cortisol in response to physiological or psychological stress. Under the stress of dental procedures (particularly surgical procedures), these patients are at risk for adrenal crisis — characterized by severe hypotension, nausea, vomiting, and cardiovascular collapse. Steroid supplementation (a 'stress dose') with hydrocortisone 100 mg IV/IM or doubling of their oral corticosteroid dose on the day of the procedure is required for invasive dental procedures. Minor procedures under local anesthesia may be performed with minimal dose adjustment but medical consultation is advised.