ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Endocrine Abstracts (2019) 66 OC8.2 | DOI: 10.1530/endoabs.66.OC8.2

Adrenal Insufficiency: hydrocortisone prescribing and sick day rules

Cameron Webb1, Heather Stirling2, Stephanie Kerr3, Justin Davies3, Hannah Batchelor1 & Emma Webb4


1University of Birmingham, Birmingham, UK; 2University Hospitals Coventry and Warwickshire, Warwick, UK; 3Southampton General Hospital, Southampton, UK; 4Noroflk and Norwich University Hospital, Norwich, UK


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 5–16 h) with the last dose being administered at 2045 h (range 1500–2400 h) and the first dose at 0630 h (range 0100–0800 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.

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