Endocrine Abstracts

Background: Adrenal insufficiency (AI) is can be often under recognised condition in the clinical practise which can potentially result in adrenal crisis or even death if not treated properly. Identification of patients who are at risk of developing AI is important in order to take appropriate steps in minimising unwanted incidents.

Objectives: Study aims to assess whether we identify patients who are at risk of AI and take recommended precautions.

Method: We performed a single centred retrospective audit at West Suffolk hospital in the United Kingdom using electronic health records to identify 57 adult patients who were on long term steroid therapy. This included oral, inhaled or injected steroids for a period exceeding 4 weeks, being prescribed by different specialties (respiratory, rheumatology, haematology, renal gastroenterology) and patients who already had the diagnosis of hypopituitarism and Addison′s disease. The records were then searched from 2016 to 2022 and data was collected on demographics, whether appropriate advice had been given and whether they were managed appropriately during inpatient stays.

Results: Over two thirds (64.3%) of patients had no alert on their record to state they were at risk of AI. Only one patient had documentation of having received a steroid emergency card. Just 22.8% of patients were documented as having an emergency intramuscular hydrocortisone pen. Documented ‘sick day rules′ advice was not given to almost two thirds of patients (67.9%). In contrast we noted 100% of patients who had the diagnosis of hypopituitarism and being followed up at endocrine clinics had been given sick day rules. Nearly one fifth of our study population comprised patients with a former diagnosis of hypopituitarism and Addison′s disease. Just less than a half of patients who had surgery or invasive procedure had been appropriately managed with pre-operative steroids. Finally, 17.5% of patients had been admitted to hospital in adrenal crisis at least once.

Conclusion: This audit report highlights the importance of raising awareness of AI among clinicians across different subspecialties and making relevant recommendations to prevent any undesired events.