Endocrine Abstracts

Research suggests regular assessment of steroid replacement therapy (SRT) is important to avoid over replacement. Also patients need regular educational updates to optimise management of SRT during illness.

Over a three-month period (2004) we surveyed SRT and knowledge in patients with primary or secondary hypoadrenalism. Patients were given a questionnaire when attending clinic. We assessed type of SRT, dose and timing; compliance with medication; patient’s knowledge of action/intervention during times of illness/vomiting and patient’s use of steroid cards and medicalerts.

Results: 80 patients were given the questionnaire and we had 56 (71%) replies. Hydrocortisone was the main SRT, with 20 mgs as the total daily dose for 18 (35%) patients, 30 mgs for 22 (43%) patients and 11 (22%) patients on doses ranging from 5mgs to 100 mgs. 25 (49%) patients took evening Hydrocortisone after 6pm with 9 (18%) taking it after 8pm. Compliance was good with 54 (97%) either never or only occasionally missing medication. 43 (77%) patients knew to increase their SRT when ill. When vomiting 19 (34%) stated they needed injected steroids and a further 23 (39%) said they would call a doctor. This suggests 37 (66%) of patients on SRT may not get the appropriate treatment when vomiting. 20 (36%) patients either did not have or did not answer the question about possessing a sick day rules leaflet. 33 (59%) of patients owned and carried a steroid card; 25 (45%) owned and carried a medicalert; 42 (75%) owned and carried at least one or the other. Patient’s knowledge of who should know they were on SRT varied.

These results suggest that there is a need for regular assessment of dosage and timing of SRT. Results indicate that patient’s knowledge of managing SRT during illness should be regularly reviewed and reinforced with appropriate education.