Background: Adrenal insufficiency remains a potentially life-threatening condition, necessitating adequate glucocorticoid replacement and appropriate stress-related adjustment to avoid crisis. Flu-like illness is a key precipitant of adrenal crisis. While some authorities recommend annual influenza vaccination for such patients, uptake rates in this population are unknown. Additionally, while seasonal vaccines may lead to minor symptoms in the general population, there are no specific recommendations on steroid management after vaccination for adrenally insufficient patients in current guidelines.
Methods: Outpatients with adrenal insufficiency attending the Endocrinology Service in one tertiary referral centre over 2018/19 were identified at randomly chosen intervals. They were prospectively asked details of influenza and pneumococcal vaccination history and any side-effects or steroid adjustment using a standard proforma. Their outpatient records were then analysed for additional disease related information.
Results: 82 patients were identified; 37 male(45.1%), 45 female(54.9%). Median age was 46(IQR=3963). 17.1% were classified as primary adrenal insufficiency, 76.8% secondary, 6.1% were on Mitotane. 74 patients were taking hydrocortisone with median daily dose of 20mg. Prednisolone was used for 8 (median dose=5.1 mg). Median time since diagnosis was 6.5 years. Overall influenza vaccination uptake was 57% (primary=42.85%, secondary=63.40%, mitotane=80%). 19.5% had received the pneumococcal vaccine within 5 years. Of patients who received the influenza vaccine, 8.5% (n=4) temporarily altered steroid replacement afterwards; 2 patients due to hypo-adrenal symptoms and 2 as precaution. 37.8% required stress dosing in the preceding year. Seven had documented adrenal crises in the preceding 5 years. 85% of those with recent crises had been vaccinated.
Discussion: Influenza and pneumococcal vaccination uptake in this adrenally insufficient population is suboptimal. Currently, the majority do not stress dose steroids after vaccination. For most of these the vaccine is tolerated without symptoms of adrenal insufficiency. Further education is required regarding appropriate vaccination in this patient group.