Case scenario

Luke is a 24-year-old male who visits your pharmacy with a repeat prescription for hydrocortisone and fludrocortisone tablets. He has been taking these medicines since being diagnosed with Addison’s disease during a recent hospital admission. Luke tells you that he is about to travel to Bali for a holiday and is worried about getting ‘Bali belly’, as he recently experienced food poisoning. On further discussion, you discover that Luke does not have a written sick-day plan and is unsure what ‘stress dosing’ means.

Learning objectives

After reading this article, pharmacists should be able to:

  • Identify the clinical features of adrenal insufficiency and adrenal crisis
  • Differentiate between primary, secondary and tertiary adrenal insufficiency
  • Outline the use of hormone replacement in adrenal insufficiency
  • Describe the pharmacist’s role in supporting patients living with adrenal insufficiency.

Competency (2016) standards addressed: 1.1, 1.4, 1.5, 2.2, 3.1, 3.5

Accreditation code: CAP2511CDMVN

Accreditation expiry: 31/10/2028

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Introduction

Adrenal insufficiency occurs when the adrenal glands don’t produce sufficient cortisol, a key hormone involved in metabolism and the body’s stress response. Depending on the underlying cause of adrenal insufficiency, other hormones such as aldosterone may also be affected.1   Patients with adrenal insufficiency typically require lifelong glucocorticoid replacement treatment, with dose adjustments required during periods o

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