Give People With Adrenal Insufficiency Emergency Kits

According to new NICE guidance, people with adrenal insufficiency should be given emergency medical kits containing hydrocortisone for intramuscular injection that can be given by anyone, including the person with adrenal insufficiency, when adrenal crisis is suspected. 

The recommendation is included in a new clinical guideline on identifying and managing adrenal insufficiency in people of all ages.

It is hoped that the move will mean those with primary or secondary adrenal insufficiency avoid an adrenal crisis and the need for emergency hospital treatment, highlighted NICE in a press release.

In a statement by the Addison’s Disease Self Help Group (ADSHG), fundraising manager Chloe Mezzetti said that an emergency hydrocortisone injection kit should always be prescribed to new adrenal insufficiency patients to prevent a potentially fatal adrenal crisis. However, “[d]ue to being a rare condition, this has not always been the case for our community,” she said.

Training how and when to use the kits should be given to people with the condition, close family members, and carers, underlined the regulator.

“This useful and useable guideline will help to ensure high quality care is offered to people with this condition and support them, their families, and carers to make informed decisions about their treatment and long-term care,” said Professor Jonathan Benger, NICE chief medical officer and deputy chief executive, in a press release.

Hospital Admissions Avoided

Adrenal insufficiency occurs when the adrenal glands do not produce enough essential hormones, particularly cortisol and aldosterone.

Conventional treatment involves corticosteroid replacement therapy with hydrocortisone for life – prednisolone and dexamethasone are less commonly used – usually taken in tablet form 2 or 3 times a day.

About 8400 people in the UK have primary adrenal insufficiency (Addison’s disease). The disease can affect people of any age but is most common between the ages of 30 and 50. It is also more common in women than men. 

Between 8500 and 15,800 people have the more common secondary adrenal insufficiency. 

NICE explained that in 2022-2023 there were 1220 hospital admissions for adrenal crisis – a potentially fatal medical emergency. It is hoped that the provision of emergency kits will reduce this figure.

Training Should Be Provided

The new recommendation details the standard equipment and information to be included in the proposed kits, including a vial of premixed hydrocortisone sodium phosphate or hydrocortisone sodium succinate powder and water, two 2 ml syringes, two blue needles, steroid emergency cards, glucose gel for babies and children younger than 16 years, and an orange needle and a 1 ml syringe for babies younger than 1 year.

People with primary and secondary adrenal insufficiency should be given two or three of these emergency kits. 

Written instructions should accompany the kits that are written in an easy-to-understand format, providing information on injection preparation and administration, and on safe needle and syringe disposal. Training should also be provided on how to use the kits. 

NICE has also provided guidance for healthcare professionals on how to spot symptoms earlier and manage the condition effectively.

“Most people with adrenal insufficiency live active lives with few limitations,” Benger said. “Our guideline will help them manage the condition effectively and keep themselves safe.”