Self-management in patients with adrenal insufficiency

References In conclusion this study contributes to the limited knowledge that is available about self-management in patients with adrenal insufficiency. Adherence to daily substitution therapy is better then expected. En route precautions and dose adaptation are two topics that need to be improved to prevent life-threatening situations in the future. Low education-level and increased age is related to good quality of self-management, al well as sex. No relation was found for the number of years patients have been diagnosed or membership of a patient association. Involvement of endocrine nurses and nurse practitioners is likely to be a key factor in the effectiveness of patient education and training. However, little research to the effectiveness of patient education and training in these patients has been done. We recommend further research to be done, to investigate the effect of educational interventions. Patients who suffer from primary and secondary adrenal insufficiency, lack the production of the hormone cortisol. Standard substitution therapy by Hydrocortisone 20 mg a day is the golden standard currently [1]. In healthy subjects, the production of cortisol by the adrenal glands is increased during disease, fever, strain, medical interventions and severe psychological stress. In patients diagnosed with adrenal insufficiency, this automatic increase of cortisol needs to be mimiced, by taking additional glucocorticoids. If a patient does not take additional glucocorticoids substitution during stress and strain, this will evoke an adrenal crisis. When the adrenal crisis remains untreated, it will result in death [2]. These acute adrenal crisis occur in a substantial proportion of patients with primary and secondary insufficiency with an overall frequency of 6.3 per 100 patient years [3]. The patients diagnosed on the endocrinology department of the Erasmus MC with primary or secondary adrenal insufficiency are instructed to double the regular substitution dose of glucocorticoids during stress and strain at own initiative. However, these advices are not always adequately followed at home, because the patients underestimate the severity of the situation.