Peri-operative guidelines for patients with or at risk of adrenal insufficiency

It is caused by the lack of the hormone aldosterone in your body, which is used to regulate the balance of salt and water. VirtualOutcomes is here to support community pharmacies and GP surgery teams with a wide range of online training courses. It covers topics https://ahlstlandsports.net from the C19 Lateral Flow Device Distribution Service to vaccines, meningitis, cervical cancer screening and the Pharmacy Quality Scheme among others. You and a partner or family member may be trained to administer an injection of hydrocortisone in an emergency.

• Back in 2020, a National Patient Safety Alert (NatPSA) was issued warning of the potential for adrenal crisis in steroid-dependent patients in the event of intercurrent illness.
• Once treatment is started you should always carry an alert in the form of the NHS steroid card and this can be supported by medical alert jewellery of your choice if desired.
• Your endocrinologist will discuss with you when an injection might be necessary.
• If Addison’s disease is suspected, blood tests will be carried out to measure the levels of sodium, potassium and cortisol in your body.
• Further symptoms of Addison’s disease tend to develop gradually over months or years.

Being aware of kidney function is important in order to maintain health. Many people live with mild and moderately low kidney function, which is often referred to by health professionals as early stage chronic kidney disease or stage 3 CKD. So it’s important to be prepared and follow our advice on coping when you’re sick.

Secondary adrenal insufficiency

This causes your symptoms to get progressively worse and eventually lead to a life-threatening situation called an adrenal or Addisonian crisis. An adrenal crisis is a medical emergency and warning signs include severe nausea, confusion, fever, headache and weakness. If you or someone you know has Addison’s disease and is experiencing severe symptoms, dial 999 for an ambulance.

• During normal health and life, when you become ill or suffer injuries the body produces increased levels of cortisol to help us survive those stresses.
• In addition, individuals receiving 3 or more intra-articular steroid injections within 12 months should be considered at risk, including for 12 months thereafter.
• At times of physiological stress such as illness, trauma or surgery there is an increased requirement for exogenous glucocorticoids, which if untreated can lead to an adrenal crisis and death.
• If the ACTH level is high, but the cortisol and aldosterone levels are low, it’s usually confirmation of Addison’s disease.
• Many people with Addison’s disease find that taking their medication enables them to continue with their normal diet and exercise routines.

They will also arrange for blood testing of your cortisol response, usually through a Synacthen test. This involves a morning in a day unit to have bloods taken before and after an injection of synthetic ACTH. The results will enable your Consultant to assess if there is any adrenal insufficiency.

Emergency Information

You might want to give this information to a friend or family member, so they can help you if you get sick. You are entitled to receive your medication free of prescription charges. Your GP must certify your entitlement to free prescriptions on a Medical Exemption card.

If a patient is Cushingoid due to exogenous steroids it is almost certain they will have adrenal suppression. Take a double oral dose (max 20mg hydrocortisone, 5mg prednisolone, 0.5mg dexamethasone) 1 hour before surgery in addition to morning dose. An ‘insulin-like growth factor-1’ (IGF-1) is made by your body when growth hormone is released. Growth hormone is produced by the pituitary gland, a small gland in your brain.

Support

Take a read or watch our latest video on management of Addison’s medication when you have COVID-19 from Professor Simon Pearce. You can find advice on preparing for hospital admission here so you can get everything ready.

Also on NHS inform

You will need to double or treble the usual dose of oral hydrocortisone until the diarrhoea stops. This is because the hydrocortisone injection takes about 8 hours to wear off and we need to make sure that it is safe for your child to go home. If your child is less alert than usual you should call a paramedic ambulance. The paramedics do not carry hydrocortisone for injection so if you haven’t given the injection, please make sure you give the emergency kit to the paramedic.

Vitamin B12 Injection

And it may sound simple, but avoiding people who are sick and washing your hands often and thoroughly can help to protect yourself and others too. Being ill can upset your diabetes management, so you need to know what to do to keep your blood glucose (sugar) levels as close to target as possible. Fortunately, cortisol can be replaced easily with daily steroid tablets. These steroid tablets are essential for your health and must never be stopped suddenly.

The New NHS Steroid Emergency Card

The specialist team will let you know what to do with your child’s dose of steroids following their operation. Order an NHS steroid emergency card to show to medical professionals if you go into an adrenal crisis. Once treatment is started you should always carry an alert in the form of the NHS steroid card and this can be supported by medical alert jewellery of your choice if desired. Diagnosis is made through assessment by your Endocrine team of your general health and well-being.

Peri-operative guidelines for patients with or at risk of adrenal insufficiency

At times of physiological stress such as illness, trauma or surgery there is an increased requirement for exogenous glucocorticoids, which if untreated can lead to an adrenal crisis and death. Missing doses of steroids for patients with adrenal insufficiency can lead to adrenal crisis; a medical emergency which if left untreated can be fatal. This is when you increase your medicine dose to keep you well during periods of stress, illness or injury.

This includes in clinics or when authorising repeat prescriptions. Wearing a medical alert bracelet will inform any medical staff treating you about your condition, and what medication you require. Aldosterone is replaced with a medication called fludrocortisone.