My pump experience

By Desley Rolph.

After being diagnosed with Secondary Adrenal Insufficiency (SAI) due to taking steroids in high doses over many years to treat my asthma, I had a year taking oral hydrocortisone without much improvement.  I do not produce any cortisol of my own due to severe atrophy of my adrenal glands, my blood tests revealed a zero cortisol and ACTH reading at diagnosis. 

Following a cortisol day curve test performed in hospital, it was determined that I was a rapid metaboliser of my oral medication and that the effectiveness of the hydrocortisone was only lasting a short time in my body (approx. 2.5 hours) , whereas it should last approximately 6 hours. This left me depleted of coverage most of the day and still very symptomatic. 

We tried various doses and increased frequency to no avail.  My endocrinologist concluded that I needed a continuous infusion with pump therapy to gain better coverage.  At the time, this was not a commonly used method in Australia, and she had to research how to go about making this happen for me.  This treatment is delivered using an insulin pump, however filling the reservoir with hydrocortisone instead of insulin.  

Switching over to the pump made a huge difference in how I felt every day.  My symptoms improved very much, in particular, the daily diarrhoea vanished within a week of treatment and my energy levels improved.  I started on the pump in 2016 and since then more people in Australia have started pump treatment. There are now more endocrinologists recognising that this can be beneficial to patients who struggle on oral medication due to either fast metabolising or their unability to properly absorb medication due to other medical conditions, particularly conditions affecting the gut.