Patients treated with immunosuppressive steroids are less aware of sick day rules Than those on endocrine replacement therapy and may be at greater risk of adrenal crisis.

BACKGROUND: Patients taking corticosteroids for immune suppression are vulnerable to adrenal crisis during acute illness or if steroids are stopped abruptly. Although patients treated for adrenal failure in endocrine units are routinely provided with sick day guidelines, we wished to ascertain whether patients on immunosuppressive steroids are appropriately advised.

AIM: This study sets out to compare patient awareness of steroid sick day rules in endocrine and non-endocrine patients.

DESIGN: A short case history is presented to illustrate the clinical impact of adrenal crisis in a patient on immune suppression. Subsequently, we present the results of a 9-point questionnaire, devised to determine knowledge of steroid sick day rules, in two patient cohorts. In group 1, patients on immunosuppressive steroids were recruited from non-endocrine clinics to complete the questionnaire. In group 2, patients on replacement steroids were recruited from endocrine clinics.

RESULTS: Endocrine patients exhibited better steroid use awareness; they were more likely to double their steroid dose when ill (89 v/s 23%), to obtain parenteral steroid during vomiting (83 v/s 27%), or during surgery (87 v/s 30%), and were aware of the need to carry a MedicAlert bracelet or a steroid-aware card (82 v/s 21%), (p < 0.001 for all comparisons).

CONCLUSION: Endocrine patients exhibited a significantly greater knowledge of sick day rules. The data does highlight the lack of patient awareness of the precautions for steroid use in patients on immunosuppressive steroid therapy for non-endocrine conditions, and the case presentation illustrates the potential hazards of this lack of awareness.