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CC BY-NC-ND 4.0 · Journal of Diabetes and Endocrine Practice 2021; 04(03): 90-92
DOI: 10.4103/jdep.jdep_42_21
Commentary

Management of adrenal insufficiency

Shazia Hussain
Department of General Medicine, Endocrinology and Metabolic Medicine, Homerton University Hospital, London
,
Sufyan Hussain
1   Department of Diabetes and Endocrinology, St Thomas' Hospital
2   Department of Diabetes and Endocrinology, King's College, London
,
Nazim Ghouri
3   Queen Elizabeth University Hospital
4   Institute of Cardiovascular and Medical Sciences, University of Glasgow
5   Department of Diabetes and Endocrinology, Queen Elizabeth University Hospital, Glasgow
,
Karim Meeran
6   Department of Medicine, Division of Diabetes, Endocrinology and Metabolism, Imperial College London
7   Department of Diabetes and Endocrinology, Imperial College London NHS Trust, London
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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]]

In the current issue of the Journal of Diabetes and Endocrine Practice, Beshyah and Ali have clearly highlighted the need for urgent clinician education on the management of patients with AI within multiple disciplines including endocrinology, in the Middle Eastern/Northern African (MENA) countries.[[11]]

Financial support and sponsorship

Nil.




Publication History

Received: 26 August 2021

Accepted: 26 August 2021

Article published online:
06 July 2022

© 2021. Gulf Association of Endocrinology and Diabetes (GAED). All rights reserved. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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