Continouos subcutaneous hydrocortisone infusion (CSHI) is a novo treatment for adrenal insufficieny. This treatment aim to mimic body circadian rhythm by providing a continouos slow infusion subcutanously.
We summarise our experience with 5 patients: 1 with primary adrenal insufficiency and 4 with secondary adrenal insufficiency. There are 1 male and 4 females with a mean age 31. All these patients were self referred and have tried various oral preparations with their local endocrinologists
A clinical protocol for CSHI was devised. Medtronic paradigm pump was loaded with Solu-Cortef hydrocortisone with each unit converting to each mg of hydrocortisone. Once commencing on CSHI cortisol series were taken during the day. AddiQoL scores were taken at baseline and at set intervals. Titration was based on symptoms, serum cortisol and 24 hours urinary cortisol.
Outcomes: Patients who were not doing well on oral steroid has poorest AddiQoL scores and gain most from the improvement in QOL scores. All 5 patients shown improvement in AddiQoL from baseline and continue to improve throughout the CSHI. Symptoms that were presence at baseline eventually subsided as we progress into the treatment. Infusion site infecton subside as the infusion rate was titrated downward based on the 24 hour urinary cortisol results. 1 patient who uses wheelchair and another who required walking stick for mobilisation eventual achieve independent on day to day activities without aid. 1 patient was able to reduce hospital admissions when started CSHI.
Conclusion: CSHI is a safe and cost effective treatment and can be used as option for patients with poor tolerance with oral steroids. More data is needed to look at the long term impact of this new treatment. More NHS centres need to provide this as an options for patients who have poor tolerance to convention steroid replacement.