Adrenal Insufficiency

Medical information to support a TUE application – Adrenal Insufficiency

Adrenal Insufficiency refers to a disorder of the adrenal glands in which steroid hormone (usually cortisol) production is impaired. Treatment of Adrenal Insufficiency generally requires the use of medication.


Status of medication in sport

Glucocorticoids are the mainstay of treatment and are prohibited in-competition.

Fludrocortisone can be used in some cases of Adrenal Insufficiency and is also prohibited in-competition.

Spironolactone is a diuretic that is used in rare cases. This medication is prohibited at all times in sport.


What information is required for a Therapeutic Use Exemption (TUE) application?

  • A completed TUE application form signed by the treating doctor and athlete.
  • Detailed typed clinical letter(s) from treating endocrinologist/paediatrician that includes:
    • accurate diagnosis – thorough clinical history and examination
    • age of onset of symptoms and of diagnosis
    • outcome of trials of alternative medications (if applicable)
    • provision of relevant blood test and other relevant imaging results confirming the diagnosis. These should include FBC, electrolytes, serum cortisol levels, and other routine measures, and
    • current treatment must be outlined including name of medication(s), route of administration, dose and frequency.

NOTE: A clinical letter can be a copy of a specialist’s letter to another doctor (e.g. a GP), and at least one of the clinical letters submitted with the application must have been written in the last 12 months.

  • Supplementary information (if available) that support the diagnosis, including:
    • ACTH stimulation test
    • CRH stimulation test
    • Antibody testing
    • Abdominal ultrasound.


For additional information please refer to the medical information relating to the condition on the WADA website.