PT  - JOURNAL ARTICLE
AU  - Helen Simpson
AU  - Jeremy Tomlinson
AU  - John Wass
AU  - John Dean
AU  - Wiebke Arlt
TI  - Guidance for the prevention and emergency management of adult patients with adrenal insufficiency
AID  - 10.7861/clinmed.2019-0324
DP  - 2020 Jul 01
TA  - Clinical Medicine
PG  - 371--378
VI  - 20
IP  - 4
4099  - http://www.rcpjournals.org/content/20/4/371.short
4100  - http://www.rcpjournals.org/content/20/4/371.full
SO  - Clin Med2020 Jul 01; 20
AB  - Adrenal insufficiency (AI) is an often-unrecognised endocrine disorder, which can lead to adrenal crisis and death if not identified and treated. Omission of steroids in patients with AI, particularly during physiological stress such as an intercurrent illness or surgery, can also lead to an adrenal crisis. The National Reporting and Learning System (NRLS) identified 78 incidents including two deaths and six incidents of severe harm to patients in a recent 4-year period. This guidance will go through causes of adrenal insufficiency, groups at risk of an adrenal crisis, emergency management and management for surgical procedures. A new NHS Steroid Emergency Card has been developed to be carried by patients at risk of adrenal crisis. We hope the new emergency card and this guidance will increase awareness of the need to start steroids promptly in patients at risk of an adrenal crisis, particularly those presenting in the emergency department or to acute medicine teams and those undergoing surgery or invasive procedures.