Daily adjustment of glucocorticoids by patients with adrenal insufficiency.
Adolescent
Adrenal Insufficiency
/ drug therapy
Adult
Aged
Aged, 80 and over
Dexamethasone
/ administration & dosage
Dose-Response Relationship, Drug
Drug Monitoring
/ methods
Female
Glucocorticoids
/ administration & dosage
Hormone Replacement Therapy
/ methods
Humans
Hydrocortisone
/ administration & dosage
Male
Medical Records
/ statistics & numerical data
Middle Aged
Prednisolone
/ administration & dosage
Prospective Studies
Reproducibility of Results
Young Adult
Addison's disease
adrenal crisis
hydrocortisone
patient's diary
Journal
Clinical endocrinology
ISSN: 1365-2265
Titre abrégé: Clin Endocrinol (Oxf)
Pays: England
ID NLM: 0346653
Informations de publication
Date de publication:
08 2019
08 2019
Historique:
received:
01
04
2019
revised:
17
04
2019
accepted:
02
05
2019
pubmed:
6
5
2019
medline:
1
9
2020
entrez:
4
5
2019
Statut:
ppublish
Résumé
Patients with adrenal insufficiency (AI) require lifelong glucocorticoid (GC) replacement. AI patients need to adjust GC dosage in response to stressful events and illness in order to prevent life-threatening adrenal crisis (AC). To evaluate self-management of patients with AI. Four German centres, which are using patient's diary as part of their routine clinical practice, instructed AI patients to prospectively document any discomfort, intercurrent illness or stressful events as well as changes in GC therapy on a daily basis. Diaries of 80 patients (44 females, 52.9 ± 15.9 years, 34 primary AI) were collected and analysed. A symptom score sheet was used to evaluate severity of discomfort. In total, 34 074 patient days (93.4 years) were recorded. 4622 days with discomfort were documented. On 35% of those days (n = 1621), patients increased their GC dose (4.8% of all days). Patients who recorded discomfort had a median of four episodes of discomfort, which lasted a median of 2 days. Women documented significantly more episodes of discomfort than men (P = 0.014). Low-to-median symptom scores resulted in GC increase by 50%-60%, whereas high symptom scores and/or fever resulted in doubling GC daily dose. However, dose increase was only 55% in situations indicating gastrointestinal (GI) infection. Severe discomfort did not always result in dose increase, especially in GI infection. However, low symptom scores resulted in an inappropriate GC increase in some patients. This underscores an urgent need for improved training methods. Keeping daily records might be a useful tool for continued and individualized patient education.
Sections du résumé
BACKGROUND
Patients with adrenal insufficiency (AI) require lifelong glucocorticoid (GC) replacement. AI patients need to adjust GC dosage in response to stressful events and illness in order to prevent life-threatening adrenal crisis (AC).
AIM
To evaluate self-management of patients with AI.
METHODS
Four German centres, which are using patient's diary as part of their routine clinical practice, instructed AI patients to prospectively document any discomfort, intercurrent illness or stressful events as well as changes in GC therapy on a daily basis. Diaries of 80 patients (44 females, 52.9 ± 15.9 years, 34 primary AI) were collected and analysed. A symptom score sheet was used to evaluate severity of discomfort.
RESULTS
In total, 34 074 patient days (93.4 years) were recorded. 4622 days with discomfort were documented. On 35% of those days (n = 1621), patients increased their GC dose (4.8% of all days). Patients who recorded discomfort had a median of four episodes of discomfort, which lasted a median of 2 days. Women documented significantly more episodes of discomfort than men (P = 0.014). Low-to-median symptom scores resulted in GC increase by 50%-60%, whereas high symptom scores and/or fever resulted in doubling GC daily dose. However, dose increase was only 55% in situations indicating gastrointestinal (GI) infection.
CONCLUSION
Severe discomfort did not always result in dose increase, especially in GI infection. However, low symptom scores resulted in an inappropriate GC increase in some patients. This underscores an urgent need for improved training methods. Keeping daily records might be a useful tool for continued and individualized patient education.
Substances chimiques
Glucocorticoids
0
Dexamethasone
7S5I7G3JQL
Prednisolone
9PHQ9Y1OLM
Hydrocortisone
WI4X0X7BPJ
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
256-262Informations de copyright
© 2019 John Wiley & Sons Ltd.