Category: Adrenal Disorders

Monitor: 12

12 - INSULIN PUMP FOR ADRENAL INSUFFICIENCY, A NOVEL APPROACH TO THE USE OF INSULIN PUMPS TO DELIVER CORTICOSTEROIDS IN PATIENTS WITH POOR CORTISOL ABSORPTION

Thursday, Apr 25
12:30 PM – 1:00 PM

Objective :

Adrenal insufficiency can lead to serious complications including adrenal crisis and death. First line of therapy is oral corticosteroids with or without fluid cortisone. With severe adrenal insufficiency, increasing oral steroid doses can worsen the side effects caused by long term use of steroids without actually improving patient symptoms. Most common side effects are weight gain, acne and purple stretch marks. Patients needing high dose need an alternative treatment method to increased oral doses. An Insulin Pump, often used for Type 1 and Type 2 Insulin Dependent Diabetics, can be used as a delivery system of steroids that can help relieve patient symptoms, reduce frequency of adrenal crisis and hospital visits and lessen side effects by lowering the corticosteroid dose.


Methods : Patients were ruled into the study if they failed oral corticosteroid therapy due to malabsorption or other barriers preventing them from exhibiting an expected cortisol profile during testing. The patients either could not absorb the corticosteroid or simply were not responding to treatment. This provided the study with 6 subjects out of 118 adrenal insufficient patients.  These 6 were switched to an insulin pump but instead using solu-cortef in a pulse fashion. The number of adrenal crisis events 6 months prior to pump treatment and 6 months post treatment was observed. Adrenal Crisis monitoring included hospitalization, emergency room visits, and symptomatic clinical visits. Symptomatic included severe fatigue, dizziness, dehydration and orthostatic symptoms, which required IV/IM steroid injections. Subject’s weight was monitored and cortisol dose was compared pre and post pump initiation.


Results :

Cortisol pumps have shown to reduce the risk of adrenal crisis by 78.5% compared to oral corticosteroids. With gradually tapered hydrocortisone via pump, the mean dose reduction is 62.77 mg compared to the oral therapy.


Discussion : The data shows that patients who once were unable to achieve appropriate treatment on oral cortisone options have been able to alieviate their cortisol related symptoms, lessen the number of adrenal crisises and achieve better quality of life. As well as lower the dose of daily cortisol recieved.


Conclusion :

Continuous plusatile cortisol replacement via pump is an option for management of severe adrenal insufficiency in patients unresponsive to oral therapy. It can reduce adrenal crisis with its bolusing flexibility while at the same time leading to lower daily doses of steroids. Overall this can improve tolerance to doses and decrease the side effects experienced from long term use of steroids and help patients with their symptoms and improving their overall quality of life.

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Abdurrahman Khalil

Research assistant
Metro Detroit Endocrinology
Detroit, Michigan

Medical Graduate of the University of Damascus interested and research and medical knowledge synthesis.

Farah Ahmed

Clinical Research Coordinator
Metro Detroit Endocrinology Center

Farah is the Clinical Research Coordinator at the Metro Detroit Endocrinology Center located in Dearborn, Michigan, USA. She completed her Bachelors of Science Degree with Honors in 2014 and went on to pursue a Masters of Science degree at Illinois Institute of Technology in 2016. Her research experience includes Neuroendocrinology, Type 1 Diabetes, Type 2 Diabetes, Prediabetes, Growth Hormone Deficiency and Adrenal Insufficiency, as well as Genetics, Bioinformatics and Cognitive Neuroscience.

Opada Alzohaili

Physician- Principle Investigator
Metro Detroit Endocrinology Center

Dr. Alzohaili is a board certified endocrinologist with over 20 years experience. He specializes in Traumatic Brain Injuries, Pituitary Deficiencies, Growth Hormone Deficiency, Adrenal Insufficiency, Diabetes, Thyroid Disorders, hormone Imbalances, and Osteoporosis.
He is the Clinical Assistant Professor at Wayne State University, Chief of Endocrinology, active teaching staff in endocrine and medicine programs at several local hospitals.
He is a frequent national and international speaker in various countries. He has also written several publications and received numerous awards for teaching.
He is the founder of Metro Detroit Endocrinology Center; one of the busiest endocrinology centers with emphasis on Traumatic Brain Injury and Pituitary Gland Disease.

Abdurrahman Khalil

Research assistant
Metro Detroit Endocrinology
Detroit, Michigan

Medical Graduate of the University of Damascus interested and research and medical knowledge synthesis.