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Adrenal (Excluding Mineralocorticoids)

SUN-453 - Impact of Alert Systems on Glucocorticoid Administration for Adrenal Insufficiency in the Emergency Department

Sunday, June 14, 2026
9:00 AM - 4:00 PM CT
Location: ENDOExpo; Poster Floor
Disclosure(s):
Ramita Anakepeerasak, MD: No financial relationships to disclose
Context: Inappropriate glucocorticoid management in adrenal insufficiency (AI) can lead to adrenal crises, particularly in an emergency setting. Clinical decision support (CDS) can be helpful, but its impact on AI management in the emergency department (ED) remains limited.

Objective: To evaluate the efficacy of CDS on glucocorticoid administration time in known AI patients presenting to the ED

Design: Retrospective study
Setting: Tertiary academic hospital
Patients: A total of 211 patients with AI; 145 had no ED visits, 66 patients had 187 ED encounters
Main outcome measures: Time from ED arrival to intravenous hydrocortisone administration pre- versus post-CDS implementation

Results: During a median follow-up of 26 months, the incidence of ED visits was 42 events per 100 patient-years, and the incidence of ED visits presenting with hypotension was 7 events per 100 patient-years. Among patients with ED visits, the number of visits was 73 before and 114 after CDS implementation. Events requiring intravenous hydrocortisone were 19 before and 24 after implementation, with treatment given in 89% vs. 92%, respectively (p=0.81). The median time from ED arrival to hydrocortisone administration decreased from 202 (IQR: 99-306) minutes to 77 (IQR: 45-153) minutes (p=0.01). The proportion of patients receiving hydrocortisone within 1 hour increased from 0% to 42% (p=0.002). New-onset hypotension occurred in 4 cases (21%) before implementation and in 1 case (4%) after implementation.

Conclusions: Following CDS implementation, the time to hydrocortisone administration was significantly shorter among patients with known AI. These findings highlight the value of CDS in improving AI recognition and management in high-risk settings.

*Unless otherwise noted, all abstracts presented at ENDO must not be released to the press or the public until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.*