Endocrine Abstracts

Background: Patients taking corticosteroids for immune suppression are vulnerable to adrenal crisis during intercurrent illness or if steroids are stopped abruptly. Although patients on glucocorticoids for adrenal failure are routinely provided with sick day rules, we wished to ascertain whether patients on immunosuppressive steroids are appropriately counselled.

Aim: This study sets out to compare patient awareness of steroid sick day rules in endocrine and non-endocrine patients.

Methods: A 9 point questionnaire to determine knowledge of steroid sick day rules was designed. 92 patients were consecutively recruited from non-endocrine clinics – respiratory (n=22), rheumatology (n=24), gastroenterology (n=20) and nephrology (n=26). 46 patients were consecutively recruited from the pituitary clinic. All patients completed the questionnaire.

Results: Endocrine patients exhibited better steroid awareness; they were more likely to double their steroid dose when ill (76.1% vs 6.5%), to obtain parenteral steroid during vomiting (82.6% vs 27.1%), and during surgery (87.0% vs 30.4%), and were aware of the need to carry a medicalert bracelet or a steroid-aware card (82.6% vs 20.7%), P<0.001 for all. However the endocrine patients were at par with the non-endocrine ones in terms of knowing the need to inform their doctor of being on steroid (91.3% vs 88.0%).

Conclusion: Endocrine patients exhibited a significantly greater knowledge of precautions for steroid use. The data does highlight the lack of patient awareness of the sick day rules in patients on immunosuppressive therapy for non-endocrine conditions. Endocrinologist could assist colleagues in other specialities in awareness of steroid sick day rules.