Endocrine Abstracts

Patients on hydrocortisone (HC) replacement for pituitary failure, Addisons disease or congenital adrenal hyperplasia are at risk of developing an Addisonian crisis if they become unwell with a severe infection or injury. This can be averted by prompt administration of intramuscular HC, traditionally by a medial professional. From 2004 we offered training to patients and a carer/partner in self-administration of HC. This was time consuming and the take up was slow. We therefore devised a one-hour group training session, led by an endocrine nurse specialist. The session covered information about steroid deficiency including the situations when an injection might be needed, together with a practical demonstration of injection technique, and an opportunity to ask questions about their condition. All participants were asked to complete an anonymous evaluation form after each session.

We identified 117 patients on our database on HC treatment, which had not yet been provided with intramuscular HC. In the first six months of the service, 57 patients were sent a letter explaining the benefits of having access to IM Hydrocortisone and inviting them to make an appointment for a group session. About 15 (26%) declined and the remaining 42 attended in groups from 2 to 7 patients. About 32 (76%) came with a partner or carer. About 32 (76%) regularly carried a steroid card and 14 (33%) had needed an injection at least once in the past. The evaluation showed that all but one patient found the group format useful and 38 felt they were confident in injection technique by end of session.

We conclude that a significant number of patients on HC replacement have required emergency HC. Group education and demonstration of emergency HC replacement is well received and is an effective and efficient means of ensuring patients and their carers have access to this vital treatment.