Endocrine Abstracts

Several recent publications have advocated that patients with primary and secondary adrenal insufficiency (PAI and SAI) be given emergency injectable hydrocortisone to reduce the risk of adrenal crisis. There is a limited evidence-base for this recommendation and consequently the Edinburgh Centre for Endocrinology (ECE) does not routinely issue kits to its patients. This study assessed the frequency of hospital presentations in ECE’s AI patients, and the severity of their condition on presentation. It also evaluated patients’ knowledge of crisis-preventing behaviours, proportions with emergency hydrocortisone kits, and the influence of these factors on presentation rates.

Details on 81 PAI and 66 SAI patients and their presentations were obtained from patient records. Data such as blood pressure and biochemistry was collected, as well as reason for admission. 81 patients participated in a telephone questionnaire, part of which assessed their knowledge of ‘sick day rules,’ as defined by Pituitary Foundation literature. Patients were also questioned about emergency kits.

54.3% of PAI and 34.8% of SAI patients presented to A&E over a 6-year period. The trends suggested that PAI patients were more likely to be hypotensive, hyponatraemic, hyperkalaemic and have low bicarbonate, but these results were not statistically significant. PAI patients were, however, more likely to be hypoglycaemic (PAI 15.4%, SAI 0.0%, P=0.048). The commonest cause of presentation for PAI patients was gastrointestinal infection, and respiratory infection for SAI. Only 16% of patients knew to go straight to A&E when vomiting. 32% possessed emergency kits, but their frequency of presentation did not differ significantly from those without (P=0.53).

Improved education strategies may be required. Further studies should establish whether or not patients with emergency kits are less unwell on presentation than those without, and it may be useful to run a comparative study between ECE and another centre which does issue emergency kits.