Introduction: Exposure to deficient/excess glucocorticoids can lead to long-term health problems in patients with adrenal insufficiency. Historically and age-appropriate hydrocortisone formulation has not been available. Adrenal crisis is associated with significant morbidity and mortality.
Aims: To assess prescribing practice for oral hydrocortisone and sick day advise across the UK.
Methods: Paediatric endocrinologists and parents[HC(UC1] of children with adrenal insufficiency from across the UK completed a survey assessing hydrocortisone dosing and sick day advise in children taking oral hydrocortisone.
Results: 32 consultant paediatric endocrinologists and 134 parents from across the UK completed the questionnaire. To achieve doses of <10 mg in children aged <6 years; 31% physicians recommend a pharmacy suspension, 28% buccal hydrocortisone and the remainder a dispersion prepared by cutting or crushing the tablet. Overall 47% of respondents are comfortable prescribing multiples of 2.5 mg sublingual hydrocortisone and 28% are comfortable prescribing half a sublingual tablet. 34% prescribe hydrocortisone solution. 30/32 consultants responded to the question on sick day advice. The following regimens were advised; double standard dose (n=8), double or triple standard dose dependent on illness severity (n=5), double the dose with an additional dose overnight (n=7), double or triple dose dependent on illness severity with an additional overnight dose (n=6), 30 mg/m2 every 6 hrs (n=4). Data on timings of hydrocortisone dosing was available from 134 parents. The average gap between overnight doses was 10.2 h (range 516 h) with the last dose being administered at 2045 h (range 15002400 h) and the first dose at 0630 h (range 01000800 h). In the last 12 months 55 out of 134 respondents (41%) reported needing to use their emergency injection.
Conclusion: There is a wide variation in hydrocortisone prescribing practice in the UK. Parents of patients who participated in this survey report a high rate of requiring emergency hydrocortisone management. Further studies should focus on the timing of reported adrenal crisis and whether this relates to the length of time between hydrocortisone doses.
27 - 29 Nov 2019
British Society for Paediatric Endocrinology and Diabetes