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Publication Type: Safety Alert
Single or Multiple Incident: Multiple
Date: 8/13/2020 12:00:00 AM
Country: United Kingdom
Organization: NHS Commissioning Board

This alert discusses the patient safety incident which can occur in patients with adrenal insufficiency and who are steroid dependent are deprived of their steroid medications. All patients with primary adrenal insufficiency, such as those with Addison’s disease, congenital adrenal hyperplasia, and hypothalamo-pituitary damage from tumours or surgery, are steroid dependent. Some patients who take oral, inhaled or topical steroids for other medical conditions may develop secondary adrenal insufficiency and be steroid dependent. Omission of steroids for patients with adrenal insufficiency can lead to adrenal crisis; a medical emergency which if left untreated can be fatal. Patients with adrenal insufficiency require higher doses of steroids if they become acutely ill or are subject to major body stressors, such as from trauma or surgery, to prevent an adrenal crisis. A recent two-year period identified four deaths, four patients admitted to critical care, and around 320 other incidents describing issues with steroid replacement therapy for patients with adrenal insufficiency or emergency treatment for adrenal crisis. The alert provides several recommended actions to reduce the likelihood of related patient safety incidents in steroid dependent individuals and stresses the value of carrying a Steroid Emergency Card.

Additional Details

steroids - oral, topical, inhaled

Steroid Emergency Card to support early recognition and treatment of adrenal crisis in adults