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

• DOI: 10.1016/j.eprac.2025.02.017
• Publication Date: 2025-03-04T00:51:15Z
• Authors: Whitaker J. Hover; Aiden D. Krein; Julia Kallet; Gregory L. Kinney; Phyllis W. Speiser; Selma F. Witchel; Diane Donegan; Alexandra Ahmet; Julia Anthony; Sofia Llahana; Susan L. Majka; Michal F. Slovick; Joshua D. Stilley; Paul L. Margulies; Michael T. McDermott; Erin A. Foley; Elizabeth A. Regan
• Keywords: Adrenal crisis; Hypertensive crisis; Rescue therapy

Individuals with adrenal insufficiency (AI) are at risk of acute crisis and death, particularly during illness or trauma, may require rapid treatment parenteral glucocorticoid such as hydrocortisone (HC) to manage a crisis. Current guidelines recommend timely self-injection in an evolving Little is known about the patient experience emergency injections. We surveyed people regarding success In 2022 survey was conducted through National Adrenal Diseases Foundation website individuals AI their caregivers managing They reported on events that required cortisol injection failure injection, context event reasons for failure, RESULTS: Nearly half (41%) insufficient patients were unable self-administer citing effects crisis-associated confusion major barriers. Failed injections led bad outcomes (sicker, need hospitalization, death) 36% cases. Effective, timely, management impending can prevent progression multisystem requiring ICU care, death. Reliance solely result worse outcomes. Treating physicians should include education specific practical instruction technique, well potential assistance FDA approval auto injector, greater engagement EMS clinicians, hospital staff, other healthcare professionals, key future crises.