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TOPLINE:

Nearly 60% of patients with adrenal insufficiency and their caregivers needed to administer emergency glucocorticoid injections, yet more than one third failed, resulting in negative outcomes. Confusion, illness, and the need for assistance were primary barriers to self-administered injections.

METHODOLOGY:

• Adrenal crisis, a severe manifestation of adrenal insufficiency, requires rapid administration of glucocorticoids to prevent life-threatening outcomes. Although considered treatable, these events often lead to poor outcomes due to system failures and lack of awareness.
• A survey conducted in 2022 through the National Adrenal Diseases Foundation website targeted adults aged > 18 years and children aged < 18 years with adrenal insufficiency or their caregivers to assess their experiences with emergency glucocorticoid injections.
• The survey comprised 17 questions and included two optional text fields for additional comments on hospital access and experiences with adrenal crisis.
• Among 657 respondents (mean age, 51.3 years; 89% women), 566 were individuals with adrenal insufficiency and 91 were caregivers for adults or children with adrenal insufficiency.

TAKEAWAY:

• Overall, 57% of respondents reported the need to administer an emergency glucocorticoid injection to manage an adrenal crisis, with 37% of them indicating the inability to administer the injection when needed. Caregivers achieved a higher success rate of administering these injections than patients (86% vs 59%; P = .0002).
• Adrenal crises were successfully stabilized in 92% of cases where injections were completely administered.
• Failure to administer injections resulted in negative outcomes, including hospitalization or death, in 36% of cases where respondents could not administer the injection. Barriers to self-administered injections included confusion, illness, isolation, and the need for assistance.
• Of those needing emergency injections, 25% were unfamiliar with the process and 58% had never practiced using a syringe to draw medication from a vial. Individuals who successfully administered injections had more experience with practice.

IN PRACTICE:

“Education about the condition and its treatment is central to this process for all stakeholders,” the authors wrote. “Our data emphasize the urgency and importance of gathering the stakeholders to initiate the comprehensive redesign of emergency care for patients with AI [adrenal insufficiency],” they added.

“Timely, effective intervention can mean the difference between recovery and a life-threatening situation,” Elizabeth Regan, MD, PhD, a physician researcher at National Jewish Health and senior author of the study, said in a press release.

SOURCE:

This study was led by Whitaker J. Hover and Aiden D. Krein, Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, National Jewish Health in Denver. It was published online in Endocrine Practice.

LIMITATIONS:

The anonymous and internet-based nature of this study limited the verification of disease status and the diagnostic records. Additionally, participants were from a patient advocacy group with extensive educational programs, which might not have represented the general population of patients with adrenal insufficiency.

DISCLOSURES:

This study did not report any funding source. One author reported being the Founder and Chief Strategy Officer for Solution Medical, which is developing injector products for adrenal crisis treatment.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.