SAT-444 Rates of Emergency Intramuscular Hydrocortisone Prescriptions in Adrenal Insufficiency

Abstract Disclosure: P. Vibhatavata: None. L.M. Mermejo: None. A.F. Turcu: None. Background: Patients with adrenal insufficiency (AI) are at risk for adrenal crisis during periods of major physical stress, particularly when oral intake or absorption is compromised. Adrenal crisis is potentially life-threating, and it requires prompt parenteral glucocorticoid administration. Emergency injectable hydrocortisone should be readily available to all patients with AI, to prevent impending adrenal crisis. Objective: To assess the rates of outpatient IM hydrocortisone prescriptions in patients with AI. Methods: We used electronic health records engines to retrieve patients diagnosed with AI in a tertiary-referral, academic center between January 2000 and July 2024. Demographics, glucocorticoid outpatient prescriptions, and adrenal crisis events were recorded. Results: We identified 14,543 patients with AI receiving oral glucocorticoids therapy, including prednisone (64%), hydrocortisone (35%), and prednisolone (0.5%). The cohort comprised 9242 (64%) women, 79% White, 11% Black, and 4% Asian individuals, with a mean age of 62 + 17 years. Only 747 (5%) patients were prescribed IM hydrocortisone for adrenal crisis prevention. During the study period, 87 patients experienced adrenal crisis, including 49 (56%) women, 81% White, 10% Black, and 2% Asian individuals, with median age 57 years. Of these, 44 (51%) had secondary AI, 41 (47%) primary AI, and 2 (2%) AI of uncertain etiology. Recurrent adrenal crises were reported in 31 (36%) patients. Only 29 (33%) patients were prescribed IM hydrocortisone prior to experiencing adrenal crisis, and 18 of them used it in a pre-hospital setting. Conclusion: Although emergency IM hydrocortisone is vital for preventing or mitigating adrenal crisis in patients with AI, it is prescribed in an alarmingly low proportion of patients. Presentation: Saturday, July 12, 2025