CION Ameerpet
Immunotherapy Late Effects · Hormone & Endocrine Reactions
Carrying a Steroid Emergency Card — Why It Matters
If you're on long-term steroid replacement after an immune-related reaction to immunotherapy — most often adrenal insufficiency or hypophysitis — an emergency team that doesn't know this can lose precious time working it out. A steroid emergency card removes that guesswork by stating your diagnosis and dosing need in writing, even if you cannot speak for yourself. NCCN and ESMO guidance on immune-related adverse events lists emergency identification as a standard part of long-term care for anyone on ongoing steroid replacement.
Medically reviewed by Dr. Bharati Devi Gorantla, Medical Oncologist, MBBS · MD · DM (Adyar, Chennai) · ECMO · MRCP SCE (UK) · Last reviewed August 2026
- A card speaks when you can't — in a crisis, it tells the ER team you need urgent steroid dosing even if you're too unwell to explain.
- It prevents a fatal delay — emergency doctors unfamiliar with cancer-related adrenal insufficiency may miss it without a clear prompt.
- It works for your caregiver too — a spouse or family member who knows where it is can act quickly on your behalf.
- It's simple to set up — just your details and dose-adjustment instructions confirmed by your endocrinologist, nothing more.
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Emergency first
Could This Be an Adrenal Crisis Right Now?
An adrenal crisis is a medical emergency in which the body can't produce enough of the hormone it needs under physical stress — it can be fatal within hours without immediate steroid treatment. If you or the person you're caring for show severe vomiting, fainting, confusion, or collapse, go to the nearest emergency room or call an ambulance now; do not wait to see if it passes.
Go to the ER now, or call an ambulance, if you see:
- Severe vomiting or diarrhoea, or being unable to keep fluids down
- Fainting, collapse, or severe dizziness
- Sudden severe abdominal, back, or leg pain
- Confusion, extreme drowsiness, or unresponsiveness
- Known adrenal insufficiency plus fever, injury, surgery, or another physical stress
For everyday questions about your card, your dose, or setting this up, call the CION helpline the same day:
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Know if this applies to you
Who Needs to Carry a Steroid Emergency Card?
Anyone on long-term steroid replacement after an immune-related reaction to immunotherapy — most often adrenal insufficiency or hypophysitis — needs to carry a steroid emergency card. This includes patients still on active treatment and those who finished immunotherapy months or years ago but remain on replacement, since the need for extra steroid cover in illness or injury doesn't end when treatment does.
- You take a daily steroid replacement tablet prescribed after immunotherapy-related adrenal insufficiency or hypophysitis
- You are between check-ups and unsure whether your body can still make enough of this hormone on its own
- You are planning surgery, a dental procedure, or travel away from your usual care team
- A spouse or family member manages your medicines and would need to explain your condition on your behalf
A simple, printable starting point
What Should a Steroid Emergency Card Actually Say?
A steroid emergency card should say, in plain words, that you take long-term steroid replacement and may need urgent extra steroid dosing if you're seriously unwell, injured, or unconscious — plus your diagnosis, your usual dose, and who to call. Ask your endocrinologist or oncology team to confirm the exact dose-adjustment instructions before you fill it in, since these are individual to you.
Sample card content — copy this layout and confirm the wording with your care team
- Name
- _____________________
- Diagnosis
- Immune-related adrenal insufficiency / hypophysitis (steroid-dependent)
- Important
- I am on long-term steroid replacement and may need urgent extra steroid treatment if I am seriously unwell, injured, unconscious, or before emergency surgery.
- Usual daily dose
- As prescribed by my endocrinologist — see attached notes
- Sick-day instructions
- As directed by my care team. Do not stop this medicine suddenly.
- Oncology team contact
- _____________________
- Endocrinology team contact
- _____________________
- Emergency contact (family/caregiver)
- _____________________
This is a plain-language starting point, not a medical document. Confirm the exact wording and dose instructions with your endocrinologist or oncology team before you carry it, and update it whenever your dose or diagnosis details change.
Timing matters
When Should You Start Carrying the Card?
There's no single moment that fits everyone — the right time is guided by your care team, not a calendar date. As a general pattern, most patients start once ongoing steroid replacement is confirmed rather than just being monitored, and continue for as long as replacement continues, which for some patients means indefinitely.
| Stage | What's typically happening |
|---|---|
| During active immunotherapy | If bloodwork confirms adrenal insufficiency or hypophysitis needing steroid replacement, most teams recommend starting the card straight away rather than waiting. |
| After immunotherapy ends | Endocrine reactions can appear or persist after treatment finishes — carrying the card continues for as long as replacement is needed, reviewed periodically by your team. |
| If replacement becomes lifelong | Some patients need steroid replacement indefinitely. The card becomes a permanent part of what you carry, renewed whenever your care team changes your instructions. |
Whether replacement continues for life is a decision your endocrinologist and oncology team make together, based on repeat hormone tests over time — never something to decide on your own.
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In the emergency room
What Should You Tell an Emergency Doctor?
Tell the emergency doctor plainly: "I am on long-term steroid replacement after cancer immunotherapy and may need urgent extra steroid treatment." Show your card immediately, mention your oncology team's name if you can, and ask them directly whether you need an emergency steroid dose before other treatment decisions are made.
- 1
Say it first, before anything else
"I am on long-term steroid replacement and may be steroid-dependent" — before describing any other symptom.
- 2
Hand over your card immediately
Even before other paperwork or ID — it's designed to be read at a glance in exactly this situation.
- 3
Name your oncology and endocrine teams
Share their contact numbers if asked — it helps the ER team confirm your history quickly.
- 4
Ask directly
"Do I need an emergency steroid dose before you do anything else?" — a direct question gets a direct answer.
- 5
If you can't speak for yourself
Make sure whoever is with you knows to say all of the above on your behalf, and knows where your card is kept.
Make it easy to find
How Do You Keep the Card Useful, Not Just Kept?
A card only helps if it's found in time. Keep a physical copy in your wallet or bag, a photo saved on your phone's lock screen or medical ID feature, and a copy with whoever usually accompanies you to hospital. Update it every time your care team changes your dose or diagnosis details — treat an outdated card as riskier than none at all.
- Keep one copy in your wallet or bag, where paramedics are trained to look
- Save a photo on your phone's lock screen or its built-in medical ID feature
- Give a copy to your spouse, caregiver, or whoever usually travels with you
- Replace it immediately if your dose or diagnosis wording changes
- Bring it to every hospital visit, not just emergencies — many admissions ask for it at triage
Care after treatment
Long-Term Hormone Care Doesn't End When Immunotherapy Does
Patients on ongoing steroid replacement are supported by the same multidisciplinary team long after their last infusion.
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Common questions
Steroid Emergency Cards: Your Questions Answered
Who needs to carry a steroid emergency card?
Anyone on long-term steroid replacement after an immune-related reaction to immunotherapy — most commonly adrenal insufficiency or hypophysitis — needs to carry a steroid emergency card. This includes patients still on active immunotherapy and those who finished treatment months or years ago but remain on replacement, because the need for extra steroid cover during illness, injury, or surgery doesn't end when immunotherapy does. If you're unsure whether this applies to you, ask your endocrinologist or oncology team at your next review rather than assuming it doesn't.
What should a steroid emergency card actually say?
It should state, in plain words, that you take long-term steroid replacement and may need urgent extra steroid dosing if you become seriously unwell, injured, or unconscious. Add your diagnosis, your usual daily dose, and the contact numbers for your oncology and endocrine teams. Ask your endocrinologist to confirm the exact wording and dose-adjustment instructions before you fill it in — these are individual to you, and a card with the wrong details can be worse than no card at all.
What should I tell an emergency doctor if I'm carrying one?
Say it plainly and first, before anything else: "I am on long-term steroid replacement and may need urgent extra steroid treatment." Hand over your card immediately, name your oncology and endocrine teams if you can, and ask directly whether you need an emergency steroid dose before other treatment decisions are made. If you cannot speak for yourself, make sure whoever is with you knows to say this on your behalf.
Is an adrenal crisis a medical emergency?
Yes. An adrenal crisis is a medical emergency in which the body cannot produce enough of the hormone it needs to cope with physical stress, and it can be fatal within hours without immediate steroid treatment. Severe vomiting, fainting, collapse, confusion, or sudden severe pain in someone on steroid replacement means going to the nearest emergency room or calling an ambulance immediately — never waiting to see if it passes on its own.
When should I start carrying the card, and for how long?
Most patients start once ongoing steroid replacement is confirmed, rather than while it's still being monitored or investigated, and continue for as long as replacement continues. For some patients that period is defined and ends after review; for others, replacement is needed indefinitely. Whether it becomes lifelong is a decision your endocrinologist and oncology team make together, based on repeat hormone tests over time — never something to decide on your own.
Can my caregiver or family member carry a copy too?
Yes, and it's recommended. A spouse or caregiver who knows where the card is and what it means can act faster than someone reading it for the first time in an emergency room. Keep at least one copy with whoever usually travels with you or accompanies you to hospital, in addition to the copy you carry yourself.