SAT-422 Retrospective Analysis of 27 Adrenal Insufficiency Patients Managed with Cortisol Pump

Abstract Disclosure: N.M. Goldenberg: None. M. Bornovali: None. M. Spivak: None. Objective: to analysis outcomes of cortisol pump use in difficult to control Adrenally Insufficient (AI) patients. Retrospective analysis of chart of 27 difficult to control patients with different versions of AI, who were started on Cortisol pump mimicking circadian/ultracadian rhythm 3 month-8 years ago. Every patient was discussed that this therapy is not FDA approved. The potential side effects were discussed and written information was provided. The analysis was conducted in 1/2025. Results: 27 Patients, 25 are female. Average age at the start of the pump is 42 yo (11-61yo).9 (33%) patients have primary AI, 2 with non-classical CAH, 7 have pituitary, 9 (33%) tertiary AI due to overuse of steroids for other conditions. 1 is on Solu-Medrol per pump (Solu-Cortef did ont work) and the rest on Solu-Cortef. 18 (67%) patient have Hypermoblity or EDS, 7 were not tested, the rest are negative. 24 of 27 (89%) report gastrointestinal issues, including 3 with Bariatric Sx, 8 with Gluten intolerance/Celiac disease, 6 with Gastroparesis; 1 with cystic fibrosis and Exocrine pancreatic insufficiency, 1 on TPN due to MCAS. 16 (59%) with POTS, 9 (33%) with diagnosed MCAS.9 patients started before May 2020, 10 started 2022-2023, 8 started in 2024. Of 27 patients 6 patients stopped using pump (22%). They stopped it 3 month-6 years after the initiatio . Three (50%) stopped due to skin reactions. One developed severe COVID and was on high doses of injectable steroids in ICU for 3 weeks and eventually transitioned to oral Dexamethasone. One patient reported that pump was not "working", was eventually able to change to different steroid regimen. One deceased due to unrelated medical issues. All but 1 patients reported that use of the pump was life changing and helped people to feel better emotionally and physically. They reported having less pre-crisis situations where they have to updose the steroids and go to ER due to adrenal issues. Discussion: in medically complex patients with adrenal insufficiency when oral steroids do not help with control of the AI symptoms, use of Steroid pump is a reasonable choice, that helps people to improve their quality of life and reduces ER visits. 22% of patients did not tolerate the treatment, most of them due to local site reaction. Longer prospective studies are needed. Presentation: Saturday, July 12, 2025