Endocrine Abstracts

Introduction: Acute adrenal insufficiency (adrenal crisis) is a life-threatening condition caused by glucocorticoid deficiency. Patient and carer education is key in the prevention, early identification and prompt management of this condition. We assessed the knowledge of adrenal insufficiency/crisis in patients with adrenal and pituitary disease to evaluate the strengths and weaknesses of local ‘sick day’ education processes.

Methods: We utilised a structured questionnaire to prospectively collect data at an outpatient Endocrine clinic from 16 patients (56.3% female, mean age 53.9 years) with primary (n=7) and secondary (n=9) adrenal insufficiency.

Results: Eleven patients (68.8%) understood the term ‘acute adrenal insufficiency’ or ‘adrenal crisis’, with 14 patients (87.5%) recollecting education on this subject. Education had been received through information leaflets (14 patients, 87.5%), physicians (nine patients, 51.3%) and websites (two patients, 12.5%). Fifteen patients (93.8%) could report some symptoms of acute adrenal insufficiency. All (100%) were aware to ‘double dose’ their oral glucocorticoid replacement during intercurrent illness. Ten patients (62.5%) were aware when intra-muscular (IM) Hydrocortisone was indicated, 8 (50%) had an in-date Hydrocortisone injection kit, of whom seven had been instructed how to administer this. Eleven patients (68.8%) reported their next of kin was aware of the risk of acute adrenal insufficiency, although only four next of kin (25%) had been taught how to administer IM Hydrocortisone. Fourteen patients (87.5%) carried a steroid treatment card and five patients (31.3%) MedicAlert jewellery. One patient (6.3%) used neither of these.

Conclusions: There is a good understanding of hydrocortisone self-management and the risk of acute adrenal insufficiency amongst patients with adrenal insufficiency at our centre. Scope exists to improve our provision of IM Hydrocortisone and education in its use and administration for both patients and their carers.