Endocrine Abstracts

Introduction: Adrenal insufficiency requires timely emergency treatment during adrenal crises. Previously, a robust information-sharing system with local ambulance services ensured that paramedics were aware of patients at risk of adrenal crisis, but this was withdrawn, creating a safety gap. We developed mechanisms including new electronic patient record (EPR) adrenal insufficiency alerts to address this safety concern. We also retrospectively reviewed the care of all patients with adrenal insufficiency under our care against the recently published NICE NG243 guidelines.

Method: We analysed EPRs of all patients with adrenal insufficiency managed between April 2023 and March 2025. Patient records and laboratory results were reviewed for retrospective compliance with NICE recommendations.

Results: From the documentation of our 180 patients with adrenal insufficiency, 94% had been counselled on sick-day rules, 91% given parenteral hydrocortisone education, 91% had renal function checked, 86% had blood pressure measured. New electronic adrenal insufficiency EPR alerts were introduced for all patients.

Conclusion: Most patients were managed in line with NICE guidance. Our Trust previously had a robust information sharing arrangement with our local ambulance services for patients with adrenal insufficiency as a crucial safety net for emergency pre-hospital parenteral steroid administration. Following the withdrawal of these alerts by the ambulance services we felt the need to introduce other reliable safety measures. We developed and implemented a specific ‘Adrenal Insufficiency’ alert in our Careflow® EPR system, referencing Trust guidelines for adrenal insufficiency emergency management. We also developed a GP template letter with all relevant information for primary care from the NICE NG243 guidelines, which requests GPs to insert an adrenal insufficiency alert in the Summary Care Record, making it visible to paramedic teams. These measures go beyond NICE guidance, which does not explicitly mandate electronic alerts, but they align with its intention of making the diagnosis visible across care settings.