Endocrine Abstracts

Adrenal crisis (AC) is a life-threatening episode of adrenal insufficiency (AI) resulting from impairment of glucocorticoid secretion by the adrenal cortex. Approximately 1 in 200 patients die from AC annually.¹ AC is often precipitated by intercurrent illness, injury or surgery and can be prevented by increasing oral corticosteroid doses (‘stress dosing’) during illness. Parenteral hydrocortisone may be necessary if oral therapy cannot be absorbed or ineffective. Patients and/or carers are instructed to carry and administer intramuscular hydrocortisone in an emergency. Research demonstrated that 47% of children and 67% of adult patients carried parenteral hydrocortisone, with 12% and 22% respectively using their injection during acute illness.¹ This study aimed to examine and address the barriers to patient use of emergency intramuscular hydrocortisone. Three virtual focus groups were conducted, via Zoom, involving 14 patients with AI (group 1=7; group 2=2; group 3=5). Audio-recordings were transcribed verbatim and analysed thematically. Participants highlighted challenges obtaining hydrocortisone ampoules and ancillaries from general practitioners to create kits. The availability of videos and pictorial leaflets describing the process of administering hydrocortisone injections were deemed valuable in supporting training of patients/relatives. CortiCit is a bespoke hydrocortisone intramuscular injection kit developed by endocrinology and pharmacy colleagues at Cardiff and Vale University Health Board. The paediatric and adult kits are manufactured specials containing two ampoules of hydrocortisone sodium phosphate 100 mg/mL, syringes and needles. A bilingual illustrated instruction leaflet, co-produced with the focus group participants and Cardiff Metropolitan School of Art and Design, is included within the kit. The leaflet has a QR code linking to a bespoke video on administering the injection. CortiCit also contains the age-appropriate national emergency steroid therapy card. The CortiCit is prescribed on hospital discharge and outpatient prescriptions across Wales, with a view to extending to GP prescribing at a later date. The CortiCit has been well received by patients/relatives with formal evaluation findings pending. The study highlights the importance of multi-disciplinary collaboration to co-produce a hydrocortisone kit that fulfils patient needs.

1. Eyal O et al. Adrenal crisis in children with adrenal insufficiency: epidemiology and risk factors. Eur J. Pediatr. 2019;178:731–738