Endocrine Abstracts

Patients with adrenal insufficiency (AI) should be informed about ‘sick day rules’ and risk of a life-threatening adrenal crisis if corticosteroids are abruptly stopped or if the steroid dose is inadequate.

Aims and Methods: To assess current practice with regard to steroid advice given across medical specialties at Oxford University Hospital Trust. To assess patient knowledge both in a specialist Endocrine department and in a medical specialty where steroids are commonly prescribed (Rheumatology). An online survey was used for the clinician survey and 5-point question survey for the patient survey.

Results: Forty-one doctors across training grades (37% IMT, 24% registrars, 39% consultants) from a range of specialties completed the survey. 56% of respondent medics stated they usually/always counselled regarding sick day rules when starting long term steroids; 20% of respondents said they rarely/never advised patients on steroid sick day rules. Only 34% of the doctors surveyed were providing the NHS steroid alert card. Sixty patients attending the endocrine clinic (34F,26M; 21 patients primary AI, 30 patients secondary AI and 9 patients with tertiary AI secondary to long-term steroid use) were surveyed and only one patient was not familiar with sick day rules. 83% (50/60) patients carried a steroid card and 70% (42/60) wore a medical alert. 25% reported a delay in receiving steroids when unwell in the past. By contrast, 0/20 Rheumatology patients had received a steroid alert card; and 40% (8/20) were unaware of steroid sick day rules; 10%(2/20)patients had experienced an adrenal crisis.

Conclusions: There is a need for patient steroid education training across the medical specialties so that all patients at risk of adrenal insufficiency are identified and educated appropriately about the risk of adrenal crisis. As Endocrinologists we should reach out to Trust colleagues in other specialties to help deliver this education.