Management of adrenocortical insufficiency with continuous subcutaneous hydrocortisone infusion: long-term experience in three patients.

Management of adrenocortical insufficiency with continuous subcutaneous hydrocortisone infusion: long-term experience in three patients.
Endocrinol Diabetes Metab Case Rep. 2015;2015:150005
Authors: Khanna A, Khurana R, Kyriacou A, Davies R, Ray DW
Abstract
UNLABELLED: To assess continuous subcutaneous hydrocortisone infusion (CSHI) in patients with adrenocortical insufficiency (AI) and difficulties with oral replacement. Three patients with AI and frequent hospital admissions attributed to adrenal crises were treated with CSHI, which was delivered via a continuous subcutaneous infusion. All three patients preferred CSHI and remained on it long term, which permitted prolonged follow-up analysis. All three patients reported symptomatic improvement, and in two cases, reduced hospital admission rates and inpatient stay lengths were observed. The cost of hospital admissions and overall treatment was reduced in all cases. CSHI offers a practical and acceptable alternative to oral replacement in a subset of patients with AI. The cost of initiating and maintaining the pump is offset in the long term by reduced frequency and duration of emergency admissions. CSHI can therefore be considered in a select group of patients who are resistant to treatment with conventional oral glucocorticoids.
LEARNING POINTS: Continuous subcutaneous infusion of cortisol is a viable alternative in patients unable to take oral steroids.Patient acceptabili...

Source: Diabetes Metab - July 3, 2015 Category: Endocrinology Authors: Khanna A, Khurana R, Kyriacou A, Davies R, Ray DW Tags: Endocrinol Diabetes Metab Case Rep Source Type: research