Endocrinology in Charlottenburg, Berlin, Germany.
Endocrinology and Diabetes Unit, Department of Medicine I, University Hospital Wuerzburg, Wuerzburg, Germany.
Exp Clin Endocrinol Diabetes. 2021 Mar;129(3):241-249. doi: 10.1055/a-1217-7208. Epub 2020 Aug 6.
Adrenal insufficiency (AI) requires life-long treatment with glucocorticoid replacement therapy. Over- or under-substitution carries the risk of increased morbidity in the form of side effects or adrenal crises. Glucocorticoid replacement therapy needs to be flexible with dose adaptation in special situations. This could not be managed by medical personnel on a daily basis, but requires an educated patient who has a good knowledge of the disease, understands his medical therapy and is able to perform situational dose adaptation. The rarity of the disease in combination with the need to respond to stressful situations with rapid glucocorticoid dose adjustment underlines that a well-trained patient is crucial for optimal management of the disease.In this literature review we provide background information further clarifying the need of education in patients with AI including the current shortcomings of medical therapy and of the treatment of patients with AI. We outline the aims of therapeutic patient education, present the concept of structured patient education in Germany, and discuss available results of patient group education programs. Furthermore, we propose strategies how therapeutic patient education for adrenal insufficiency can be organized under COVID-19 pandemic conditions.
肾上腺功能不全（AI）需要终身接受糖皮质激素替代治疗。超量或不足替代都有增加发病率的风险，表现为副作用或肾上腺危象。糖皮质激素替代治疗需要根据特殊情况灵活调整剂量。这不能由医务人员每天管理，而是需要一个受过教育的患者，他对疾病有很好的了解，理解他的医学治疗，并能够进行情况剂量调整。这种疾病的罕见性，加上需要应对应激情况，这就需要迅速调整糖皮质激素剂量，这突出表明，对于疾病的最佳管理，接受过良好培训的患者至关重要。在这篇文献综述中，我们提供了背景信息，进一步阐明了 AI 患者教育的必要性，包括目前医学治疗和 AI 患者治疗的不足。我们概述了治疗性患者教育的目标，介绍了德国结构化患者教育的概念，并讨论了患者群体教育计划的现有结果。此外，我们提出了在 COVID-19 大流行期间如何组织肾上腺功能不全的治疗性患者教育的策略。
