Endocrine Abstracts

Aims: Adrenal crisis (AC) is a life- threatening condition with an incidence of 6–10 adrenal crises per 100 patient year in European populations. The aim of our study is to identify the prevalence of adrenal crisis in our clinic population and assess the preventative measures in use.

Methods: Data was obtained from electronic records and paper records were reviewed in adrenal crisis patients.

Results: There were 230 patients with adrenal insufficiency identified from January 2015 to May 2016 from our clinic. These include 36% Addison’s disease (PAI), 10% primary adrenal insufficiency without Addison’s disease (PAI -woAD) and 54% secondary adrenal insufficiency (SAI). We had 42 admissions with AC in 230 patients since 2010. Thirty-nine in PAI, 1 PAI –woAD and 2 SAI. In PAI group, 18 patients had AC; nine patients had two or more episodes. The common causes were gastroenteritis (54%), respiratory tract infections (15%) and acute kidney injury (5%). The prevalence of AC per 100 patient year was 11 in PAI, 0.4 SAI and 0.9 PAI-woAD. 150 (65%) had documented information regarding steroid identifiers (bracelet, necklace or steroid card), with 9 (4%) carrying no identifiers. There was inadequate information for the remaining 71 (31%). In terms of steroid education, formal teaching (FT) was provided by specialist nurses and informal teaching (IT) consists of verbal information during annual review. Eighty one (98%) patients with PAI received IT. FT was delivered in 30 (36%) of PAI, 3 (13%) of PAI-woAD, 26 (21%) in SAI.

Conclusion: Patients with PAI have more frequent AC compared to the other groups and received correspondingly more FT and IT. Structured education for all patients with adrenal insufficiency with additional emphasis on PAI patients must be delivered on a rolling basis.