Management of adrenal insufficiency

Abstract

Patients with adrenal insufficiency (AI), irrespective of whether the cause is primary, secondary, or tertiary, require glucocorticoid replacement, without which they can suffer life-threatening consequences from an adrenal crisis. There have been a number of reported preventable cases of adrenal crises due to various reasons including inappropriate omission of glucocorticoids and failure to increase doses during acute illnesses. [1] The role of the patient in recognizing when an increase in glucocorticoid doses is required is central to minimize the risk to themselves; thus, the importance of patient education is repeatedly emphasized. [2,3] Published existing literature has identified deficiencies in the patients' understanding of steroid sick day rules, [2,4] how to administer parenteral hydrocortisone, [2,4,5] and when to seek medical attention. [2] However, reports highlight gaps in clinician knowledge, particularly on the recognition, and the management of AI. [4,[6][7][8] Given that healthcare professionals have a central role in patient education, it is essential that clinicians, irrespective of grade are familiar with steroid sick day rules and pharmacokinetics to avoid preventable adverse patient outcomes. Furthermore, the increasing use of drugs such as immune checkpoint inhibitors and the endocrinopathy side effects associated with these further supports the need for all physicians, not just endocrinologists, to recognize, and promptly initiate treatment AI. [9,10]