In this highly informative podcast, Dr. Lewis Blevins reviews a recent article by the Journal of Clinical Endocrinology and Metabolism on Hypopituitarism in Adults. The article was published in October 2016. After you listen to the podcast, we recommend that if you have Hypopituitarism, you get this article and keep it in your files for reference.
Please follow this link to the article’s abstract, with directions on how to obtain it.
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Hi Dr Blevins,
Overall I found your critique of the JCEM document good. I have previously read the article. I have SAI from previous steroids for asthma and had undetectable cortisol and almost undetectable ACTH on synacthen testing, and I am on a pump because of serious fast metabolism issues. I do have the injectable Solu Cortef Act-o-Vial, used it twice, and each time the ED has been glad I did before I arrived. I feel concerned that you believe because of shelf life, you don’t recommend patients having this on hand. This is where I have to disagree with you wholeheartedly. I am very much aware of deaths that have occurred because a patient did not have this injection on hand. One very sad story is of a young lady, Katie Berry (whose mother would not in the least mind me sharing her story as she openly blogs about her and is always willing to share her story), who suffered a critical adrenal crisis at home, that saw her collapse in the bathroom in the morning and die, only to be revived after 35 minutes and remain in a coma for several weeks and is now a living young woman (23 years) who has suffered awful brain damage and has spent a year in rehabilitation to now come home, requiring so much assistance. Her mother states that this is not the life she envisioned for her beautiful young daughter. You see, her endocrinologist chided her in their request for the emergency injection saying she lived within minutes of a major hospital, underplayed the danger of AC, and did not need one. She was frequently unstable around the time of her period and the evening before this tragic event, she felt a little unwell with a slight tummy upset. As it was around breakfast time, where she lived was clogged with traffic and it took the ambulance too long to get there. They also did not carry hydrocortisone for injection. This is a sad a tragic story that could have been prevented had she had the Act-o-vial on hand, her mother would have been able to inject her when she first collapsed, instead seeing her daughter’s heart stop in their own home. I really don’t see that shelf life should be a deterrent to supplying this medication. We can all read the use buy date and if we toss it out unused and have to fill another script, it is a small price to pay to save our lives. I really don’t think there is any excuse to not prescribe this to patients. They should also be shown how to use it. As is recommended in this article by a team of other experts/colleagues. I would really like to see you reverse your decision on this. It is quite unrealistic and downright dangerous situation you put your patients in. One day when one of your patients suffers from a sudden adrenal crisis, you may indeed regret it.