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How to manage adrenal insufficiency in hospital?

Answer

The management of adrenal insufficiency in a hospital setting involves several key steps, including corticosteroid replacement, monitoring, patient education, and management of adrenal crisis.

Corticosteroid replacement

Monitoring

Patient education

  • Stress dose corticosteroids: Patients should be educated regarding appropriate adjustment of corticosteroid dosing during stressful events and regarding adrenal crisis prevention strategies including parenteral self- or lay-administration of emergency corticosteroids

Management of adrenal crisis

  • Primary adrenal insufficiency: Immediate therapy with stress-dose intravenous hydrocortisone is recommended in patients with symptoms of severe adrenal insufficiency or adrenal crisis, prior to results of diagnostic tests
  • Corticosteroid-induced adrenal insufficiency: Adrenal crisis should be suspected in patients with current or recent corticosteroid use who have not undergone biochemical testing to rule out corticosteroid-induced adrenal insufficiency and present with hemodynamic instability, vomiting, or diarrhea. These patients should be treated with parenteral corticosteroids and fluid resuscitation

In conclusion, effective management of adrenal insufficiency in the hospital involves prompt recognition and treatment with appropriate corticosteroid replacement, careful monitoring of therapy, educating patients on stress dosing and emergency measures, and being prepared to manage adrenal crisis promptly to prevent serious complications.

References

1

Primary adrenal insufficiency

Medical management

Guidelines

Management of adrenal crisis

Pathway
ES 2016