Glucocorticoid replacement therapy in adrenal insufficiency &amp;mdash; a challenge to physicians?

Harbeck, Birgit; Brede, Swantje; Witt, C. A.; Süfke, Sven; Lehnert, Hendrik; Haas, Christian

doi:10.1507/endocrj.ej14-0612

Cited by 19 publications

(19 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…including inadequate levels of knowledge about AI/AC among clinicians [8, 38,39]. Ignorance about 239 the importance of an AC as a medical emergency can result in patients communicating the need for 240 urgent treatment to hospital staff, only to be ignored or have the treatment refused, some with severe 241 consequences [9,10].…”

Section: Diagnosis and Clinical Considerations 38 39mentioning

confidence: 99%

Adrenal crises: perspectives and research directions

2016

View full text Add to dashboard Cite

Adrenal crises are life-threatening complications of adrenal insufficiency. These events have an estimated incidence of between 5 and 10 adrenal crises/100 patient years and are responsible for some of the increased morbidity and excess mortality experienced by patients with adrenal insufficiency. Treatment involves urgent administration of IV/IM hydrocortisone and IV fluids. Patient education regarding preventive measures, such as increasing the dose of replacement therapy ("stress dosing") when sick, using parenteral hydrocortisone as necessary and accessing medical assistance promptly, is still considered the best approach to averting the onset of an adrenal crisis at times of physiological stress, most commonly an infection. However, recent evidence has demonstrated that patient education does not prevent many adrenal crisis events and the reasons for this are not fully understood. Furthermore, there is no widely accepted definition of an adrenal crisis. Without a validated adrenal crisis definition it is difficult to interpret variations in the incidence of adrenal crises and determine the effectiveness of preventive measures. This article aims to review the clinical aspects of adrenal crisis events, to explore the epidemiology, and to offer a definition of an adrenal crisis and to offer a perspective on future directions for research into adrenal crisis prevention.

show abstract

Section: Diagnosis and Clinical Considerations 38 39mentioning

confidence: 99%

Adrenal crises: perspectives and research directions

2016

View full text Add to dashboard Cite

show abstract

“…Experts considered 30 minutes as a time limit for “card‐injection‐time” in case of an AC within the same trial . Further studies indicate an insufficient knowledge of physicians on AI . Only 9.6% of the interviewed physicians identified all situations requiring GC adjustment correctly .…”

Section: Introductionmentioning

confidence: 97%

Management of adrenal emergencies in educated patients with adrenal insufficiency—A prospective study

Burger-Stritt

Kardonski

Pulzer

et al. 2018

Clinical Endocrinology

View full text Add to dashboard Cite

show abstract

“…The lack of knowledge regarding the underlying disorder in affected AI patients clearly demonstrates that additional efforts should be made by the treating physicians to inform in detail and a comprehensible way on the disease. Of note, we previously also revealed significant knowledge gaps in physicians of different hospitals and specialties with respect to therapy of AI [14,15]. While these results probably cannot be generalized to endocrinologists working at Endocrine outpatient clinics, our data rather emphasis that treatment of AI patients is of concern to all physicians, as inconsistent information given by physicians may confuse patient and therefore making it difficult for them to gain or maintain the skills they need to prevent or treat acute AI.…”

Section: Discussionmentioning

confidence: 57%

“…Presumably, additional information on GC replacement therapyprovided by the treating physicians -has a beneficial effect on drug adherence of AI patients [12]. However, we recently demonstrated that also physicians may lack knowledge on AI, which may result in inadequate treatment of the disorder [14,15].…”

Section: Limited Patients' Knowledge Of Their Form Of Adrenal Insuffimentioning

confidence: 94%

Self-management in adrenal insufficiency — towards a better understanding

et al. 2017

Self Cite

View full text Add to dashboard Cite

CORTISOL is an essential stress hormone produced by the adrenal glands and tightly regulated via the hypothalamic-pituitary-adrenal axis. Cortisol deficiency is a rare, but life-threatening condition, requiring immediate diagnosis and treatment. The most common cause of primary adrenal insufficiency (AI) is an autoimmune process [1], but also infections, tissue infiltration, drugs or surgery may lead to insufficient production of glucocorticoids (GC) in the adrenal glands [2]. Secondary and tertiary AI are most often due to a pituitary adenoma or traumatic injury [3].Regardless of the aetiology, patients with cortisol deficiency need an individual substitution treatment plan, which has to be adjusted in stressful situations. Abstract. Patients with adrenal insufficiency (AI) require life-long glucocorticoid (GC) replacement treatment and dose adjustment in stress situations to prevent life-threatening adrenal crises. Herein this study we evaluated the patients' healthcare situation and their knowledge on AI, comparing various aspects to a prior survey in 209 physicians. Using a questionnaire, we conducted a comprehensive survey among 33 AI patients who were treated at the endocrine outpatient clinics of two University Hospitals in Germany. The majority of AI patients (97%) named their treating physician as main source for information. Overall, 89.7% of interviewees were satisfied with their medical treatment; however, about 1/3 reported controversies with healthcare professionals regarding GC replacement in various situation. Two thirds of AI patients increased their substitution dose temporarily within the last 12 months. However, not all patients had an emergency ID, and only 64.5% an emergency kit. None of the interviewed patients identified the need for adjustment in all given situations correctly. Almost 80% of patients did not correctly identify all symptoms of GC over-and under-replacement. Interestingly, we found no significant differences between patients and physicians regarding specific aspects of GC replacement. We showed that: (i) AI patients have some knowledge gaps on modalities and adequacy of GC replacement therapy; (ii) long-term management of patients with AI remains a challenge requiring an experienced specialist; and (iii) further education of physicians as primary source of information is necessary. Additional education may help AI patients to empower them to adequate self-treatment. Self-management in adrenal insufficiency

show abstract

Glucocorticoid replacement therapy in adrenal insufficiency — a challenge to physicians?

Cited by 19 publications

References 9 publications

Adrenal crises: perspectives and research directions

Adrenal crises: perspectives and research directions

Management of adrenal emergencies in educated patients with adrenal insufficiency—A prospective study

Self-management in adrenal insufficiency — towards a better understanding

Contact Info

Product

Resources

About

Glucocorticoid replacement therapy in adrenal insufficiency &mdash; a challenge to physicians?

Cited by 19 publications

References 9 publications

Adrenal crises: perspectives and research directions

Adrenal crises: perspectives and research directions

Management of adrenal emergencies in educated patients with adrenal insufficiency—A prospective study

Self-management in adrenal insufficiency &mdash; towards a better understanding

Contact Info

Product

Resources

About

Glucocorticoid replacement therapy in adrenal insufficiency — a challenge to physicians?

Self-management in adrenal insufficiency — towards a better understanding