People With Adrenal Insufficiency Who Are in Adrenal Crisis Are Frequently Unable to Self-Administer Rescue Injections

Abstract

Objective: Individuals with adrenal insufficiency (AI) are at risk of acute adrenal crisis and death, particularly during illness or trauma, and may require rapid treatment with parenteral glucocorticoid such as hydrocortisone to manage a crisis. Current guidelines recommend timely self-injection in an evolving crisis. Little is known about the patient experience with emergency injections. We surveyed people with AI regarding success with emergency injections.

Methods: In 2022 a survey was conducted through the National Adrenal Diseases Foundation website of individuals with AI or their caregivers about experience with managing an adrenal crisis. They reported on adrenal crisis events that required an emergency cortisol injection and the success or failure of the injection, context of the event and reasons for failure.

Results: Nearly half (41%) of adrenal insufficient patients were unable to self-administer an emergency glucocorticoid injection, citing effects of their crisis-associated illness and confusion as major barriers. Failed injections led to bad outcomes (sicker, need for hospitalization, or death) in 36% of cases.

Conclusions: Effective, timely, management of an impending adrenal crisis can prevent progression to hospitalization, multisystem failure requiring intensive care unit care, and death. Reliance solely on patient self-injection may result in worse outcomes. Treating physicians should include patient education about injections and specific practical instruction in the technique, as well as the potential need for assistance in a crisis. US Food and Drug Administration approval of a glucocorticoid autoinjector, greater engagement with Emergency Medical Services clinicians, hospital emergency staff, and other health care professionals, is key for future success in managing adrenal crises.

Keywords: adrenal crisis; adrenal insufficiency; autoinjectors; education; emergency injections; hypotension.