Introduction: Patients with adrenal insufficiency (AI) lack endogenous cortisol and require oral hydrocortisone. In primary AI (PAI) endogenous aldosterone synthesis is also lost and patients require oral fludrocortisone. Important long-term issues include wearing MedicAlert jewellery (MAJ) and adequacy of steroid replacement including fludrocortisone, assessed by plasmarenin activity (PRA).
We identified patients with AI attending our unit and aimed to: i) assess patient education and practices regarding MAJ and ii) assess the frequency of PRA measurement and the levels of same compared with current guideline targets.
Methods: The hospitals Patient Correspondence System identified letters including the terms Adrenal Insufficiency and Addisons Disease. Such identified patients were classified as having primary or secondary AI. Recent hydrocortisone and fludrocortisone doses were recorded. Patients were contacted using registered telephone numbers and invited to participate in the study. Electronic laboratory results were reviewed for PRA measurements.
Results: Review of >200 letters identified 39 patients with AI, 21 with PAI and 18 with Secondary AI. 21 patients were successfully contacted and consented to a telephone survey. Of these, 20 (95%) were aware of the need for MAJ and 62% owned MAJ. Among patients with PAI 67% had a PRA performed in the past 5 years and 47% in the previous year. Two thirds of patients had PRA above the recommended target range.
Discussion: Patients with AI require complex and long-term follow-up. Establishing a database of AI patients allows for audit of patient care and adherence to current guidelines. Patients attending our unit are well advised on the need for wearing MAJ but less than two thirds of patients own MAJ. PRA, a useful measurement in determining appropriate fludrocortisone replacement was available on less than half the patients for the previous year and even when available was above the recommended target in over two thirds of patients.