Endocrine Abstracts

Introduction: Adrenal insufficiency can arise from a variety of conditions that disrupt endogenous steroid synthesis ⁽¹⁾. Those with adrenal insufficiency are at risk of developing adrenal crisis, which is often precipitated by acute illness. It can be underdiagnosed and undermanaged in the paediatric population⁽¹⁾. This quality improvement project (QIP) aims to review the confidence of staff and parents/carers, in a district general hospital, in recognising increased risk of adrenal crisis and ensuring its prompt and effective management.

Methods: Two questionnaires were distributed to two distinct groups: carers of paediatric patients regularly monitored for adrenal insufficiency, and paediatricians and emergency department staff who assess acutely admitted patients. The questionnaires included a mix of closed and open-ended questions designed to evaluate confidence in identifying individuals at risk of adrenal crisis, making appropriate adjustments to steroid medications, and managing adrenal crisis effectively.

Results: Out of the 10 questionnaires sent to parents/carers, 7 were completed and returned. All respondents had three in-date emergency hydrocortisone kits stored in appropriate locations. However, only 43% felt very confident in administering emergency intramuscular hydrocortisone, while 28% indicated a need for more frequent reminders on how to administer it. Among the 16 clinicians from the paediatric emergency department and the main paediatric department who responded, none felt very confident in identifying and managing patients at risk of adrenal crisis. Additionally, 15% of the clinicians were unaware of any existing guidelines to aid in the management of adrenal crisis.

Conclusion: The questionnaires revealed two key areas for potential improvement in managing paediatric patients at risk of adrenal crisis: (1) empowering clinicians to feel confident in managing these patients, and (2) providing regular education to parents/carers on administering emergency medications. Based on these findings, we have developed a QIP aimed at addressing both areas.

References: (1) Nisticò D, Bossini B, Benvenuto S, Pellegrin MC, Tornese G. Pediatric Adrenal Insufficiency: Challenges and Solutions. Therapeutics and Clinical Risk Management. 2022 Jan;Volume 18:47–60.