Q: What can an Addison patient do about jet lag when travelling across time zones e.g. The States with a five hour difference. The person in question was really ill for five days with flu like symptoms.

A: When crossing time zones replacement therapy should be quite simply managed: I advise my patients that they should take their normal doses during the day prior to setting out for a flight. If they are taking 20 milligrams of hydrocortisone on waking as their normal replacement dose I would then suggest that they take 10 milligrams of hydrocortisone each 6 hours until they reach their destination when they should resume their normal pattern on hydrocortisone replacement according to clock time. If they are on less than this dose in the morning they should take their normal morning dose 6 hourly in the same way. Fluodrocortisone should simply be taken according to clock time. If your member had taken her medication in this way she would not have had a related illness with flu like symptoms-perhaps she had an inter-current infection that was nothing whatsoever to do with her replacement therapy.