Endocrine Abstracts (2003) 6 S26

Steroid replacement therapy: the challenges of medication management in adrenal insufficiency, with reference to insights from patients' experiences

KG White1, SJ Baker2 & A Elliott3


1Addison's Disease Self-Help Group; 2Addison's Disease Self-Help Group; 3Addison's Disease Self-Help Group.


With the right balance of daily medication, individuals with adrenal insufficiency can expect to have a normal life span and to lead busy and rewarding lives. Despite this, research finds that people with adrenal insufficiency often feel below par compared to healthy individuals.(1)(2) One recent study found that the rate of hospital admission for adrenal crisis is almost three times higher for women with autoimmune adrenalitis than it is for patients with secondary adrenal insufficiency.(3)

This seminar will consider the challenges for people with primary adrenal insuffiency (Addison's disease) as they relate to medication management. It will draw on the findings of the 2003 international membership survey undertaken by the UK Addison's Disease Self-Help Group in collaboration with the Australian Addison's Disease Association and Canadian Addison's Society. Professor John Wass of the Radcliffe Infirmary, Oxford, has generously given his time to supervise this research; preliminary analysis of this survey data will be available in autumn 2003.(4)

Specifically, the seminar will address:

1. The importance of the timing for steroid replacement therapy and the number of split doses per day.

2. Crisis prevention and crisis management, with reference to patient education and the role of paramedics.

3. Quality of life in Addison's disease, relative to a control group of healthy volunteers.

4. The prevalence of related endocrine/autoimmune conditions in autoimmune adrenalitis, particularly hypothyroidism, diabetes and coeliac disease; the implications of these 'disease clusters' for quality of life and medication management.

Endnotes:

(1) Lovas K, Loge JH, Husebye ES. Subjective health status in Norwegian patients with Addison's disease. Clinic. Enocrinol. (Oxf) 2002; 56: 581-88

(2) Hunt PJ, Gurnell EM, Huppert FA, et al, Improvement in mood and fatigue after Dehydroepiandrosterone replacement in Addison's disease in a randomised, double blind trial J. Clin. Endocrinol. Metab. 2000; 85: 4650-56

(3) W Arlt W and Allolio B, Adrenal insufficiency, The Lancet 2003; 361: 1881-93

(4) Further details of this survey are available at www.adshg.org.uk

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