Endocrine Abstracts

Patients with adrenal insufficiency should be prescribed stress dose steroids in acute settings to avoid adrenal crisis. Adrenal crisis is life-threatening if not recognized and if treatment is delayed. This audit aimed to identify the current practice of sick-day rule management in University Hospital Limerick of admitted patients with adrenal insufficiency. A cross-sectional analysis was conducted on inpatients referred for endocrinology consultation for adrenal insufficiency from January 2023 to December 2023. 59 patients had a diagnosis of adrenal insufficiency. 64.4% female (n = 38). The majority (52.5%, n = 31) had glucocorticoid-induced adrenal insufficiency, 25.4% (n = 15) had known primary adrenal insufficiency, 18.6% (n = 11) had ACTH deficiency. Aetiology was unknown in 2 patients. 45.8% (n = 27) of patients were on hydrocortisone and 37.3% (n = 22) were on prednisolone. Glucocorticoid replacement therapy was not specified in 10 patients. 86% (n = 51) of patients had more than one hospital admission per year. Initial blood pressure was noted in 40 patients. 17.5% (n = 7) of patients had systolic BP of <100mmHg. Only 17% (n = 10) received stress dose in the emergency department before referral to the medical/surgical service for admission. This was administered within 1 hour in 4 patients. 6 patients received the stress dose after an hour. The median time for glucocorticoid administration was 2 hours and 37 mins (Range, 12 mins - 7 hours and 22 mins). 37.3% (n = 22) had required stress dose due to concurrent infection, 27.1% (n = 16) due to surgery, and 27.1% (n = 9) due to non-specific acute illness. 8.5% (n = 5) were deemed not to require stress dose. 16.8% (n = 10) had required admission to HDU. 50.8% of patients had a length of stay of >14 days. The audit showed suboptimal inpatient sick day rule management. It highlights the need for more education for NCHDs and nursing colleagues on the importance of sick day rule management in patients with adrenal insufficiency.