Endocrine Disorders: Adrenal Insufficiency

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Introduction

Law enforcement officers (LEOs) with well-controlled adrenal insufficiency may be capable of safe and effective job performance. However, LEOs with adrenal insufficiency may have clinical manifestations which can interfere with their ability to perform essential job functions or may cause sudden incapacitation. Therefore, an individualized assessment of the LEO is needed to ensure safe and effective job performance.

Such evaluation must include the following key elements:

• The history of the adrenal insufficiency
• Prior and current treatment
• The risk for sudden incapacitation
• Presence of any adrenal insufficiency complications

Overview of Medical Evaluation

The treating endocrinologist or other treating physician knowledgeable regarding the management of adrenal insufficiency should provide the police physician with relevant medical records, medical data and/or responses to specific questions that indicate whether the LEO has met the criteria set out below.

LEOs with adrenal insufficiency can be cleared for full duty if they meet the following criteria:

• No postural hypotension defined as a fall in systolic blood pressure of at least 20 mm Hg or diastolic blood pressure of at least 10 mm Hg when assuming a standing position
• No current adrenal crisis (see Appendix)
• No incapacitating symptoms due to adrenal insufficiency
• Has had education on how to prevent adrenal crisis

LEOs with any of the following signs or symptoms need to be restricted and referred to their treating provider and re-evaluated after treatment.

• Postural hypotension
• Current adrenal crisis
• Dehydration
• Weakness