Pharmacists and their teams are on the front line of healthcare. The services they offer are easily accessible and patients rely on pharmacists and their teams for advice and support relating to their health. As such pharmacists may come into contact with a pituitary patient who is dependent on hydrocortisone (HC). Hospital pharmacists might also be involved in hydrocortisone prescribing, for a patient on a ward or a newly diagnosed patient through the Endocrinology Department.
Hydrocortisone is taken as a replacement for the natural hormone where this is deficient, either because there is a failure of hydrocortisone production by the adrenal gland (primary adrenal insufficiency - Addison’s disease), or pituitary deficiency of ACTH (the hormone that stimulates the production of hydrocortisone by the adrenal gland). Some pituitary patients have secondary adrenal insufficiency and require replacement HC therapy.
The symptoms of adrenal insufficiency are non-specific, and are often similar to the symptoms of depression or flu, for example:
- Appetite loss
- Increased thirst
- Weight loss
- Irregular or infrequent periods
- Low mood
- Weak muscles/painful joints
When patients who have adrenal insufficiency, (like some pituitary patients who have secondary adrenal insufficiency), become unwell they can be at risk of going into an adrenal crisis because their body is unable to naturally increase the output of steroid from their adrenals to help the body overcome the illness or stress situation. If a patient is unable to take their normal replacement dose of hydrocortisone or indeed the dose is not sufficient for the acute shock/ illness, they urgently need a higher dose of hydrocortisone (usually by 100mg injection). Unfortunately, too often, healthcare workers do not realise the urgency of treatment for acute adrenal crisis.