How to make an Adrenal Crisis Care kit

In the event of an adrenal crisis, a cortisol replacement injection must be administered. Do not ever hesitate to inject an adrenal insufficient patient with cortisol replacement medication if they are experiencing an adrenal crisis.

Items needed in an Adrenal Crisis Care Kit:

  • • Cortisol Replacement Medication Vial
  • • Alcohol Prep Wipes
  • • Intramuscular Syringes (It is recommended to have at least 2 just in case)
  • Instructions on how to administer cortisol replacement via injection. AAF’s QR code can be scanned to immediately access dosing instructions. (You can download this QR code at the link https://drive.google.com/file/d/1DfkwOgEMEqcyTrvJU_t5IFF0eJeOKA33/view

How to Administer Solu-Cortef Acto-Vial Emergency Cortisol Injection

  1. Remove the two-chamber vial containing Solu-Cortef Act-O-Vial from the packaging.
    a. Press the colored cap down to mix solvent with the powder solution of hydrocortisone.
    b. Mix the contents until the powder is dissolved. The powder solution of hydrocortisone is completely dissolved once the solution is clear
  2. Remove the protective disc from the center of the plastic cap of the vial.
  3. Wipe top of vial with alcohol swab to sterilize it before inserting syringe into bottle.
  4. Insert the syringe into the vial. Turn the vial upside down and draw the solution into the syringe.
  5. Hold the syringe like a dart and push the needle for 2/3 of its length into the chosen injection site at a right angle to the skin.
  6. Give the injection into intramuscular tissue such as the buttock or in the upper thigh muscle.

What if my doctor refuses to prescribe an emergency cortisol injection?


Prescribing a cortisol replacement emergency injection is a documented, standard treatment protocol for patients with any form of cortisol deficiency. If your doctor refuses to prescribe an emergency injection, you can provide your physician with the informational links posted below regarding the importance of providing an emergency cortisol replacement injection to treat an acute adrenal crisis.


If they continue to refuse to provide you with this life saving prescription, they can be reported to the medical board. Ignorance on care protocols for rare disease treatments is common, which is why doctors must be willing to educate themselves with documented research. However, negligence and refusal to provide standard care is unacceptable and should be reported to the medical board in order to prevent harm from occurring.

Having an emergency adrenal crisis care kit is vital to the management of adrenal insufficiency. Please do not continue receiving care under a physician who is unwilling to properly manage cortisol deficiency.

Supporting links:
https://pubmed.ncbi.nlm.nih.gov/29763143/#:~:text=Adrenal%20crisis%2C%20also%20termed%20acute,soon%20upon%20arrival%20in%20hospital

https://www.pituitary.org.uk/information/publications/adrenal-insufficiency/letter-to-gp-digital-template/


More information on managing adrenal disease can be found in our book, Adrenal Insufficiency 101: A Patient’s Guide to Managing Adrenal Insufficiency
Available at the link:
https://www.amazon.com/Adrenal-Insufficiency-101-Patients-Managing/dp/1734907304

This information has been brought to you by the Adrenal Alternatives Foundation and is not to be used to provide medical care. Adrenal Alternatives is a nonprofit, patient advocacy organization dedicated to advocacy & access for all cortisol care.

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Updates on the TwistJect Emergency Cortisol Injection Device

Adrenal Alternatives Foundation is a proud affiliate of SOLUtion medical, which is a company creating an auto-injecting device to deliver the lifesaving cortisol injection. This article contains the latest updates [2022] from  SOLUtion Medical about the Twistject device!

You can also listen to the podcast interview with SOLUtion’s founder, Julia Anthony, at the following link-  TwistJect Podcast Episode

SOLUtion Medical is developing a one-step injector for delivering adrenal crisis medication in a rescue situation. This incredible innovation will eliminate the need for cumbersome and confusing rescue kits, and replace those kits with a single, one-step device. This upcoming device automatically mixes medication without requiring shaking or visual monitoring. Initial data shows the product mixes hydrocortisone sodium succinate powder approximately 20X faster than the current standard of care in only one user step.

SOLUtion’s design teams, Neuma and IDE have been focused on the optimization and full integration, assembly, and prototyping of this device and recently finished the first complete prototype integration and demonstration successfully.

With their device prototype, SOLUtion has completed “hands-on” demonstrations with patients and advocacy groups to glean initial feedback from partners, patients, and caregivers. They are also planning to conduct a “human factor” study this year [2022] with The Children’s Hospital of Pennsylvania (CHOP). Having adrenal insufficiency herself, SOLUtion’s founder has maintained the focus of the product to be the usability and the human factors aspects of the device.  

On their drug formulation effort, they have optimized partners and supply chains and are working with two UK firms – Nova Labs (formulation) and Intertek (analytical) – to deliver the drug to the required specifications. These new formulation partners can offer potential cost/development savings.

SOLUtion was pleased with the promising analytical results of the optimized spray drying formulation and are moving forward with finalizing the formulation for manufacturability.

SOLUtion also completed a pricing and reimbursement strategy and payer stakeholder engagement and were very encouraged by the results, which included interviews with payer pharmacy benefit managers and medical directors. Based on this effort, they expect patients will have full access to the Twistject device across public and private payers, with no restrictions, no step through therapy (i.e. fail other methods first before changing), no prior authorization, and strong reimbursement rates.

Additionally, they are in the process of primary market research with patients and caregivers, to better understand their needs, the number of prescriptions per year, the number of crises per year, and other information relating to current adrenal crisis medication utilization. SOLUtion has had over 400 global survey respondents, which helped them better understand patient and caregiver needs, as well as aid them in payer discussions and negotiations.

SOLUtion Medical continues to expand external relationships and was selected to be part of the NASDAQ Milestone Maker Program, which has already led to several meetings with potential strategic partners for distribution worldwide.

This incredible company continues to build momentum and we are excited to support their ongoing efforts to make the Twistject device a reality!

To hear more about SOLUtion’s work, please join us for the Live Q & A event to be hosted on the Adrenal Alternatives Foundation facebook page on June 20, 2022 at 2:00pm EST.

This live event will feature SOLUtion’s founder, Julia Anthony, as she answers questions from the adrenal community regarding the upcoming Twistject Device.

You can also visit their website at: https://solutionmedllc.com/

This content was brought to you by, Adrenal Alternatives Foundation, a non profit, volunteer, patient empowerment organization providing advocacy and access for all cortisol care options. EIN: 83-3629121.

Ways to Get involved:

Sign up for our email list.

Listen to our Podcast on Spotify, iTunes & Anchor:

Read our publications:

Cortisol Pump 101 Guide Book

Adrenal Insufficiency 101 Book

Attend an online or in person event.

Schedule a consult with a team member for cortisol care support.

Purchase Adrenal Awareness Merch from our online store.

Donate:

Text the word GIVE to 833-807-5813 or donate at www.paypal.com/paypalme/adrenalalternatives

More information can be found on our website:

Cortisol Injection Instructions QR Code

An adrenal crisis is defined as a life- threatening, medical emergency caused by insufficient levels of the hormone, cortisol. It will lead to death if left untreated and must be quickly addressed with the administration of an emergency cortisol injection. Adrenal patients should always carry an emergency injection and administer it immediately in the event of an adrenal crisis. Patients should also wear an identifying medical alert bracelet that states they are steroid dependent.

Adrenal Alternatives Foundation has created a QR code which can be scanned to instantly access the lifesaving information on how to administer an emergency cortisol injection to treat an adrenal crisis.

How to Scan a QR Code

  1. Open the QR Code reader on your phone.
  2. Hold your device over a QR Code so that it’s clearly visible within your smartphone’s screen. Two things can happen when you correctly hold your smartphone over a QR Code.
    1. The phone automatically scans the code.
    2. On some readers, you have to press a button to snap a picture, not unlike the button on your smartphone camera.
  3. If necessary, press the button. Your smartphone reads the code and navigates to the intended destination, which doesn’t happen instantly. It may take a few seconds on most devices.

Inject Don’t Neglect!

Always administer an emergency cortisol injection in the event of an adrenal crisis.

This information was brought to you by the Adrenal Alternatives Foundation for educational use only and is not meant to provide medical care or legal advice.

More information on managing adrenal disease can be found on in the book A patient’s guide to managing adrenal insufficiency.

We appreciate all contributions which allow us to further our mission, Education, Encouragement and Advocacy for all adrenal disease.

Donate to Adrenal Alternatives Foundation

Upcoming Adrenal Technology- Twistject Cortisol Delivery Device Update

Adrenal Alternatives Foundation is a proud affiliate of SOLUtion medical, which is a company creating an auto-injecting device to deliver the life saving cortisol injection.

We were privileged to interview SOLUtion’s founder, Julia Anthony on the latest updates for the TWISTject device!

You can also listen to the full podcast episode:

  1. Please introduce yourself. 

Julia Anthony, Chief Executive Officer of SOLUtion Medical. 

  1. What form of adrenal disease were you diagnosed with?

I was diagnosed with Salt-Wasting Congenital Adrenal Hyperplasia (SWCAH) at birth. This is a rare, chronic, autosomal recessive genetic condition requiring daily medication for the rest of my life, and rescue injection during an adrenal crisis. 

  1. Can you tell us about SOLUtion medical?

SOLUtion Medical is developing a one-step injector for delivering adrenal crisis medication in a rescue situation. With our device we plan to eliminate the need for cumbersome and confusing rescue kits, and replace those kits with a single, one-step device.

  1. What updates can you tell us about upcoming developments for the TwistJect device?

Our device automatically mixes medication without requiring shaking or visual monitoring. Initial data shows our product mixes hydrocortisone sodium succinate powder approximately 20X faster than the current standard of care in only one user step. We are presently working to optimize our product for manufacturing. 

Our immediate goals are to complete the design process to define how our device will be manufactured in medically compliant manufacturing, a non-trivial process. We expect to obtain approvals throughout the world so our device can be obtained by anyone at risk of an adrenal crisis regardless of location.   

Longer term, we envision our device as applicable to many different drugs and treatments, allowing more at-home usage of a variety of medications requiring mixing directly prior to injection. 

  1. How will your invention change the future of adrenal crisis management?

By simplifying rescue injections, more sufferers of adrenal insufficiency will be empowered to carry and use their rescue medication. This will reduce mental burden, increase compliance, and improve the lives of those with adrenal insufficiency.

  1. What goals do you hope to accomplish with your work?

Virtually everyone at risk for an adrenal crisis must carry a rescue kit, and these kits are not straightforward or easy to use. As a result, too few people inject themselves with rescue medication at the onset of an adrenal crisis, resulting in longer hospital stays, lower quality of life, and even death. A simple, easy to use device will reduce complexity and difficulties of injections, providing an “EpiPen” like experience that is intended to improve compliance of rescue injections during an adrenal crisis. 

  1. What is the timeline for the availability of the TwistJect device?

Developing and obtaining regulatory approvals for a drug device combinatorial product can be a long process.  We are targeting late 2024 for product launch, with hopes of delivering the device sooner. Much depends on the time spent during the regulatory approval process. 

  1. How complex of a project is the creation of your device from concept to production?

It is fairly complex, especially because our product is a combinatorial product, meaning it combines two regulated components, the rescue drug and the drug delivery device. Manufacturing, testing, documentation, and other regulatory compliance add multiple layers of complexity on top of normal manufacturing adding to both time and cost. These processes are all individually understood, but combining them into a product such as this is certainly non-trivial.

  1. What is something you want to tell the adrenal community?

You and your voice matter. Use it – for yourself and to empower others in the adrenal and rare disease communities. 

  1. How do you balance work and living with adrenal disease?

The forever present and typically invisible (when well-managed) chronic condition that is SWCAH makes work-life balance – an already challenging equilibrium – even more difficult. I am lucky to be surrounded by a talented and passionate team who are understanding of my condition and its affects. At the end of the day, it is thinking about the individuals and families we aim to help through our work that keeps me going. 

For more information on SOLUtion medical you can visit their website: https://solutionmedllc.com/

The Adrenal Alternatives Foundation is registered with the IRS as a 501(c)3 nonprofit organization.

EIN: 83-3629121.

This information was brought to you by the Adrenal Alternatives Foundation for educational use only and is not meant to provide medical care or legal advice.

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