Audit on management of chronic adrenal insufficiency
Rk Rao, A Brahma & H Gray
Background: Glucocorticoid replacement is life saving in adrenal insufficiency. There are established guidelines for management of adrenal insufficiency. This audit was under taken to evaluate whether we are implementing these guidelines in our day to day management of patients with adrenal insufficiency.
Method: A retrospective study was performed on 18 patients. Data was collected from clinical records on the proforma and were evaluated against the recommendations from 2004 Endocrine Society Annual meeting, UK. The age range varied from 33 to 90 years. There was equal number of patients in both sexes. Aetiological causes of adrenal insufficiency were autoimmune, metastasis and pituitary surgery.
Results: Symptoms were documented in a generalized manner. Specific symptoms of glucocorticoid over/under replacement were documented in 39%. There was clear documentation of stress related steroid dose adjustment in 33%. Postural drop of BP was documented in 61%. Peripheral oedema was documented in 27%. TSH was measured periodically in 89%. Only in 11% of patients, serum Renin levels were measured. Serum electrolytes were monitored in all the patients.
Conclusions: Symptoms of glucocorticoid over/under replacement should be specifically enquired and documented. Detailed account of stress related glucocorticoid dose adjustment should be specifically enquired during each visit and documented. Reinstruction of stress related glucocorticoid dose adjustment should be done in each visit. Emergency bracelet/steroid card should be verified and documented. Peripheral oedema and postural drop of blood pressure should be actively looked for in every patient with chronic adrenal insufficiency. If there are any concerns regarding mineralocorticoid dose adjustment, plasma renin activity should be measured.