Clinicians educate adrenal insufficiency patients taking nondexamethasone glucocorticoids who initiate enzyme-inducing antiepileptic drugs about early signs of adrenal insufficiency. Trigger when an AI patient on nondexamethasone GC starts an enzyme-inducing AED such as phenytoin, carbamazepine, or oxcarbazepine.
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name: ata-aed-ai-education
description: Clinicians educate adrenal insufficiency patients taking nondexamethasone glucocorticoids who initiate enzyme-inducing antiepileptic drugs about early signs of adrenal insufficiency. Trigger when an AI patient on nondexamethasone GC starts an enzyme-inducing AED such as phenytoin, carbamazepine, or oxcarbazepine.
---
# Educate adrenal insufficiency patients on enzyme-inducing antiepileptic drugs about early AI signs
## STEP 1 — Gather Information
Confirm adrenal insufficiency diagnosis, verify current glucocorticoid regimen (nondexamethasone), identify newly prescribed enzyme-inducing AED, assess baseline symptoms.
**Action:** If patient meets criteria, proceed to Step 2.
## STEP 2 — Rule In / Rule Out
Determine if the patient is on nondexamethasone GC and has started an enzyme-inducing AED (e.g., phenytoin, carbamazepine, oxcarbazepine, phenobarbital, primidone).
**Action:** If yes, proceed to Step 3; if no, no further education needed.
## STEP 3 — Classify or Stratify
Assess baseline cortisol replacement adequacy and recent symptoms; classify as stable AI patient requiring education on early AI signs.
**Action:** Proceed to structured patient education.
## STEP 4 — Decide
Provide education on early AI signs (fatigue, weakness, nausea/vomiting, abdominal pain, hypotension, hyponatremia, hypoglycemia) and instruct patient to contact clinician or seek emergency care if symptoms develop; review stress-dose guidelines.
**Action:** Document education and schedule follow-up.
## Clinical Guardrails / Mimics / Pitfalls
Do not delay education until symptoms appear; do not assume patient recognizes subtle signs; do not overlook drug interactions that may reduce glucocorticoid efficacy; do not forget to advise about emergency injectable glucocorticoid kit.
## Concrete Clinical Example
A 34-year-old woman with secondary AI on hydrocortisone 15 mg AM/5 mg PM starts carbamazepine for focal seizures; clinician educates her about early AI signs; two weeks later she reports mild nausea and fatigue, contacts clinic, receives stress-dose hydrocortisone, avoids adrenal crisis.
**Source:** Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2016, 10.1210/jc.2016-2118
