Endocrine Abstracts

JOINT2553

Background: Adrenal crisis is a life-threatening condition needing urgent injectable hydrocortisone. Without prompt treatment, it can lead to severe complications. NICE Guidance recommends educating patients on sick day rules and providing them with emergency hydrocortisone injection kits.

Aim: The project aimed to determine the percentage of adrenal insufficiency patients prescribed emergency hydrocortisone kits.

Methods: A retrospective review of case notes from secondary Endocrine Clinics within the Swansea Bay University Health Board was conducted, examining demographic data, causes of adrenal insufficiency, and emergency hydrocortisone kit prescriptions.

Results: 118 patients with adrenal insufficiency (47% Male; Mean age 60.5±16.7 years) were included. Causes of adrenal insufficiency included Addison disease 35 (30%); secondary adrenal insufficiency 57 (48%); iatrogenic 15 (13%) and Others [Bilateral adrenalectomy, congenital adrenal hyperplasia, immunotherapy related adrenalitis] 11 (%). 15 out of 118 had immunotherapy related adrenal insufficiency (13 patients had hypophysitis and 2 had adrenalitis). Majority (77%) were treated with hydrocortisone and the reminder treated with prednisolone. All patients received sick day rule education and 92% (108) were prescribed with emergency hydrocortisone kit. In the last 12 months, 15 patients (9 with secondary adrenal insufficiency, 4 with Addison disease, 2 with iatrogenic) were admitted with adrenal crisis. Precipitating factor for adrenal crisis was infection (gastroenteritis, COVID, pneumonia, urinary tract infection). Out of 15 patients with adrenal crisis, 2 patients were not prescribed with emergency hydrocortisone injection kit.

Conclusion: Most patients with adrenal insufficiency were prescribed injectable hydrocortisone, and adrenal crisis can occur in all types of adrenal insufficiency. Educating patients on sick day rules and ensuring they have emergency hydrocortisone is crucial in preventing adrenal crisis. Notably, 13% of patients with an adrenal crisis had not received injectable hydrocortisone. Ensuring all patients (and/or their family members) receive education and emergency hydrocortisone injection techniques is essential for effective management and prevention of adrenal crisis. This study emphasizes the importance of consistent and comprehensive patient education and access to emergency treatment to mitigate the risks associated with adrenal insufficiency.