Impact of Residual Adrenal Function on Adrenal Crises and Infections
Research type
Research Study
Full title
Assessing the Impact of Residual Adrenal Function on Adrenal Crises and Infections: Can we Direct Educational Resources?
IRAS ID
251143
Contact name
Julie Lynch
Contact email
Sponsor organisation
Leeds Teaching Hospitals NHS Trust
Duration of Study in the UK
1 years, 5 months, 31 days
Research summary
As well as improving patient symptoms, the aim of glucocorticoid replacement in Adrenal Insufficient (AI) patients is to prevent deaths from intercurrent infections and adrenal crises. Glucocorticoid requirements increase with stresses (both physical and emotional), patients are taught to increase their glucocorticoid replacement in times of intercurrent illness, and to use slight increases in dose for emotional and physical stresses. Many Endocrine Units have developed educational programs, both for groups and individuals, to explain when to increase their glucocorticoids and by how much. These programs additionally include teaching of how to administer intramuscular hydrocortisone in times of intractable vomiting, or severe illness. We have previously shown that many patients forget the need to increase their glucocorticoids, and thus this education requires repetition every 1-2 years, although the frequency of this has not been established robustly. Furthermore, it appears that all patients are not at similar risk. More than half of individuals with AI never have an adrenal crisis following their initial diagnosis, and the patients who have regular, or repeated, adrenal crises account for only around 15% of patients with AI.
Patients with secondary AI are thought at lower risk of symptoms and adrenal crises, due to the fact that cortisol levels in these individuals are low, although not completely absent. However, we are now aware that a number of patients with Addison’s disease also continue to maintain a degree of cortisol secretion. This residual adrenal function (RAF) may thus be protective against adrenal crises and infections, reducing considerably the risk of adrenal crises and intercurrent infections. Therefore by examining RAF and correlating with the number of crises and intercurrent infections may allow us to identify a ‘high risk’ group that educational resources can be directed towards, to hopefully improve outcomes.REC name
North East - Tyne & Wear South Research Ethics Committee
REC reference
18/NE/0355
Date of REC Opinion
13 Nov 2018
REC opinion
Favourable Opinion