Hover Whitaker J, Krein Aiden D, Kallet Julia, Kinney Gregory L, Speiser Phyllis W, Witchel Selma F, Donegan Diane, Ahmet Alexandra, Anthony Julia, Llahana Sofia, Majka Susan L, Slovick Michal F, Stilley Joshua D, Margulies Paul L, McDermott Michael T, Foley Erin A, Regan Elizabeth A
Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, National Jewish Health, Denver, Colorado.
Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado.
Endocr Pract. 2025 May;31(5):625-630. doi: 10.1016/j.eprac.2025.02.017. Epub 2025 Mar 3.
Individuals with adrenal insufficiency (AI) are at risk of acute adrenal crisis and death, particularly during illness or trauma, and may require rapid treatment with parenteral glucocorticoid such as hydrocortisone to manage a crisis. Current guidelines recommend timely self-injection in an evolving crisis. Little is known about the patient experience with emergency injections. We surveyed people with AI regarding success with emergency injections.
In 2022 a survey was conducted through the National Adrenal Diseases Foundation website of individuals with AI or their caregivers about experience with managing an adrenal crisis. They reported on adrenal crisis events that required an emergency cortisol injection and the success or failure of the injection, context of the event and reasons for failure.
Nearly half (41%) of adrenal insufficient patients were unable to self-administer an emergency glucocorticoid injection, citing effects of their crisis-associated illness and confusion as major barriers. Failed injections led to bad outcomes (sicker, need for hospitalization, or death) in 36% of cases.
Effective, timely, management of an impending adrenal crisis can prevent progression to hospitalization, multisystem failure requiring intensive care unit care, and death. Reliance solely on patient self-injection may result in worse outcomes. Treating physicians should include patient education about injections and specific practical instruction in the technique, as well as the potential need for assistance in a crisis. US Food and Drug Administration approval of a glucocorticoid autoinjector, greater engagement with Emergency Medical Services clinicians, hospital emergency staff, and other health care professionals, is key for future success in managing adrenal crises.
肾上腺功能不全（AI）患者有发生急性肾上腺危象和死亡的风险，尤其是在患病或遭受创伤期间，可能需要迅速用胃肠外糖皮质激素如氢化可的松进行治疗以控制危象。当前指南建议在危象进展过程中及时进行自我注射。关于患者进行紧急注射的体验知之甚少。我们就紧急注射的成功率对AI患者进行了调查。
2022年，通过国家肾上腺疾病基金会网站对AI患者或其护理人员进行了一项关于管理肾上腺危象体验的调查。他们报告了需要紧急注射皮质醇的肾上腺危象事件、注射的成功或失败情况、事件背景及失败原因。
近一半（41%）的肾上腺功能不全患者无法自行进行紧急糖皮质激素注射，称与危象相关疾病的影响和意识模糊是主要障碍。36%的注射失败病例导致了不良后果（病情加重、需要住院或死亡）。
对即将发生的肾上腺危象进行有效、及时的管理可防止病情发展至住院、需要重症监护病房护理的多系统衰竭以及死亡。单纯依靠患者自我注射可能会导致更糟的结果。治疗医生应包括对患者进行注射相关教育及技术方面的具体实际指导，以及告知患者在危象时可能需要他人协助。美国食品药品监督管理局批准糖皮质激素自动注射器、与紧急医疗服务临床医生、医院急诊人员及其他医疗保健专业人员加强合作，是未来成功管理肾上腺危象的关键。
