Recently published guidance on the prevention and emergency management of adult patients with adrenal insufficiency (AI) outlined the general issues relating to adrenal crisis. This was subsequently supported by an NHS national patient safety alert, promoting the use of a new Steroid Emergency Card to support the early recognition and treatment of adrenal crisis in adults. It specified a number of actions that organisations need to implement to operationalise the introduction of the new Steroid Emergency Card.

However, it has become clear that many groups need support on how to identify patients at risk of AI from exogenous steroids. The Society for Endocrinology Steroid Emergency Card Working Group and Specialist Pharmacy Services have published a new document offering guidance and expert opinion for challenging clinical issues around AI.

The 4 areas of recommendation are:

1. Which patients are at risk of HPA axis suppression from exogenous steroids
2. Who should be issued with a Steroid Emergency Card and have sick day rules advice for intercurrent illness, procedures and surgery
3. Who should have steroid cover for procedures, surgery and acute intercurrent illness
4. Who requires adrenal function assessment

Read the full document.