Well, isn’t this what we patients have been trying to get folks to
do for many moons.
The editorial concludes "listening to a well informed patient
in adrenal crisis who says that he or she need steroids and taking urgent
action will avoid unnecessary deaths from this eminently treatable medical
problem."
How to avoid precipitating an acute adrenal crisis
Reference: BMJ 2012;
345: e6333
Source: British Medical
Journal
Date published: 09/11/2012
16:53
Summary
by: Yuet Wan
An editorial in the
BMJ highlights the risks of failing to recognize the need for hydrocortisone in
patients at risk of adrenocortical insufficiency (adrenal or addisonian
crisis).
The authors note
that all too often, healthcare workers do not realize the urgency of treatment
for acute adrenal crisis or fail to heed the requests of well informed patients
for hydrocortisone. They reiterate that patients with adrenal insufficiency are
at risk of developing life threatening adrenal crisis if steroids are reduced
or stopped, or if glucocorticoid treatment is not increased during periods of
increased stress.
In this article,
they describe the situations in which acute adrenal crisis can occur, features
of acute adrenal crisis, its treatment, and cite examples where patients with
Addison's disease who present unwell to healthcare services have their requests
for hydrocortisone administration turned down or delayed. The authors question
why there is such mismanagement? They draw attention to guidelines for the
perioperative management of such patients on the websites of the Society for
Endocrinology (www.endocrinology.org/),
the Addison's Disease Self Help Group (www.addisons.org.uk/)
and the Pituitary Foundation (www.pituitary.org.uk/).
In addition, the Addison's Disease Self Help Group can issue hospital stickers
to be put on to drug charts to draw attention to a patient's steroid
dependency.
The editorial
concludes "listening to a well informed patient in adrenal crisis who says
that he or she need steroids and taking urgent action will avoid unnecessary
deaths from this eminently treatable medical problem."
