Steroid-dependent individuals, in particular those with primary adrenal insufficiency, are a vulnerable patient group. They are prone to acute adrenal crisis which is a life-threatening medical emergency requiring immediate recognition and treatment. Among individuals with primary adrenal insufficiency, acute adrenal crisis has a frequency of 68 per 100 patient-years. Unfortunately, delays in diagnosis and management are common, constituting an avoidable source of patient harm.
In the UK, the endocrine community has taken important steps in recent times to improve the safety of steroid-dependent patients. These include the publication of the Society for Endocrinology emergency guideline for the management of adrenal crisis in adult patients, the introduction of a pan-European Steroid Emergency card and patient resources including a video series on giving a steroid injection in an emergency.
In Newcastle upon Tyne Hospitals, we have embedded steroid safety teaching and adrenal crisis management into mandatory trust induction, implemented an electronic record-based steroid alert system and set up a hospital-initiated ambulance service registration pathway for steroid-dependent patients. The aim of these interlocking safety measures is to improve patient care and prevent serious clinical incidents.