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Endocrine Abstracts (2018) 59 P012 | DOI: 10.1530/endoabs.59.P012

Adrenal and steroids

Newly diagnosed adrenal patients are poorly prepared to manage adrenal crisis

Katherine White

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Addison’s Disease Self-Help Group, Guildford, UK.


Steroid-dependence is a life-long condition with a risk of premature mortality from undertreated adrenal crisis or omission of steroids. Previous studies identified rates of adrenal crisis around 8.3/100 patient years (Hahner 2015). We invited members of Addison’s Disease Self-Help Group to complete an online questionnaire about any experiences of adrenal crisis. Respondents(N=628) were asked to provide demographic information and details of their most recent adrenal emergency. 74 people (12%) reported diagnosis <12 months previously. Concerningly, 34% of this cohort had already experienced 1 – 3 episodes of post-diagnosis adrenal crisis. Only 35% reported vomiting as a trigger factor; 35% also reported flu-like illness with fever as a cause. 26% reported anxiety, bereavement or severe emotional stress as a trigger; 22% reported dehydration, sunstroke or overexertion. The most common time of day for the newly-diagnosed to realise they needed emergency treatment was 18:00 – 24:00 (35%), followed by 06:00 – 12:00 (30%). 63% had an injection kit in their possession at the time of their most recent adrenal crisis (N=23), but only 19% were able to self-inject or receive IM hydrocortisone from a partner. 27% were treated by ambulance crew, 27% by A & E staff, 18% by a GP, nurse or other hospital doctor. 9% recovered by taking extra oral hydrocortisone. Over half of this cohort were taken to hospital by ambulance; over 40% were admitted for 1+ days. Only 22% said they had received 1-1 training in injection method from an endocrine nurse. A further 26% receiving 1-1 training from a GP, practice nurse or other hospital specialist. These findings emphasize that adrenal patients should be adequately trained in self-management for adrenal crisis prevention at the time of diagnosis, to preserve life. Adrenal patient education should not be postponed until later followup appointments in outpatient clinics.

Volume 59

Society for Endocrinology BES 2018

Glasgow, UK
19 Nov 2018 - 21 Nov 2018

Society for Endocrinology 

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