Endocrine Abstracts

Introduction: Adrenal insufficiency (primary/secondary) is a rare and potentially life-threatening condition which can be easily overlooked. Patient awareness and management of problems is critical and central to effective treatment. The NICE Clinical Knowledge Summaries for patients identifies and recommends critical areas that require attention in adrenal insufficiency. In particular, patients should:

i) Realize the need for lifelong glucocorticoid replacement treatment. ii) Know how to adjust their replacement steroid medication. iii) Know how to recognize the symptoms of an adrenal crisis and how to give intramuscular hydrocortisone in an emergency (family member should also know). iv) Understand the importance of carrying emergency information.

The aim of this audit was to determine if further strategies need to be implemented for our practice to comply with guidelines.

Method: In a retrospective analysis of 71 patients with adrenal insufficiency we reviewed clinical documentation and objective data (clinical observations, biochemical results and educational information including emergency hydrocortisone injection kits).

Results: We found that:

i) 100% of patients received complete education as recommended including issuing of emergency hydrocortisone injection kits.

ii) 99% had medication documented with 67/71 (94%) on hydrocortisone and 44/67 (66%) taking 10-5-5. Eleven of 67 (16%) on higher doses, 7/67 (10%) on lower doses, 5/67 (7%) no dose recorded. Two patients were taking Plenadrin (20 and 15 mg) and two on Prednisolone.

iii) 54% had a blood pressure recording, 17% above 140/80. 60% had U&E’s recorded.

Conclusion: For good practice, clinicians must ensure all patients with adrenal insufficiency receive education about the importance of steroid replacement. This can be provided in group sessions or on a 1:1 basis by Endocrine Nurses. The majority of patients were on the recommended replacement regimen. However, we will need to review those on other regimens to ensure these are appropriate and tailored to patient’s needs.