Adrenal emergency is a regular event for treated Addisons patients
Katherine White1, John Wass2, Alyson Elliott1 & Wiebke Arlt3
Acute adrenal insufficiency requires immediate treatment with high-dose glucocorticoid and represents a life-threatening emergency. Previous research suggests that primary hypoadrenalism patients (Addisons disease) are more vulnerable to adrenal emergency than steroid-dependent pituitary patients (Arlt & Allolio 2003).
In 2006, we surveyed the membership of the UK Addisons disease Self-Help Group, comprising 982 hypoadrenalism patients, and asked if they had needed emergency treatment within the previous year.
Eight percent (74 patients) replied to say they had needed hospital treatment with injected hydrocortisone and/or intravenous fluids within the past 12 months.
Vomiting and/or diarrhoea were the most common causes (55%), followed by: dehydration/overexertion (11%); inadequate steroid cover during surgical recovery (6%); fever/influenza (5%); shock (5%), injury (4%). Other causes included urinary tract/chest infections, septicaemia, heart attack, heat stroke, and severe diabetic hypoglycaemia.
Three-quarters (76%) of adrenal emergencies occurred at home. Nine percent were overseas (Switzerland, Spain, Greece, Dubai, Tunisia, Kenya, India, Caribbean, Canada and Australia), 7% were at the house of a friend or relative, 4% were at a UK hotel, 2% were in their car, 2% were in the countryside and 1% were at work or university.
Seventy-two percent of respondents (178) had an in-date supply of injectable hydrocortisone, most of these (80%) prescribed by the GP. But only 12% gave themselves the emergency injection; a further 17% were given the injection by a partner, relative, friend or neighbour.
Over 70% relied on medical personnel for their first-line emergency treatment (4% ambulance personnel, 23% GP/nurse, 38% hospital personnel).
These findings show that patient education regarding the risks of hypocortisolaemia, the need for prompt emergency treatment and the practical technique for self-injection remain an important responsibilities for the endocrinologist.