Professional practices in the management of adrenal insufficiency in two tertiary referral hospitals (Tunis, Tunisia)
Abstract
Background: Adrenal insufficiency (AI) is a rare and life-threatening disease. Glucocorticoid replacement therapy and patient education are crucial. Few
is known about physician practice in this topic.
Aims: To describe physician practice in the management of AI and to identify the associated factors.
Methods: the physicians, all grades and specialties, from two university hospitals in Tunis, were invited to respond to a paper-based 16- multiple choice
item-questionnaire about the management of AI and the prevention of acute AI. Each question was scored 1 if correct or 0 if incorrect. The global score
was calculated by adding the score of the first 15 questions.
Results: 200 physicians responded to the questionnaire, sex ratio: 0.47, mean age: 29.0 ± 5.8 years (24 - 60). The overall rate of correct answers was
59.6%. The rate of correct responses was good for the type of replacement therapy (92%), the lifelong duration of treatment (88%), the symptoms of
overtreatment (73.5%), the type of diet indicated (77%), and the necessity of special measures during the peri operative period (100%). However, the rate
of correct responses was low for the half-life of hydrocortisone (12.5%), biological signs suggesting acute AI (17.5%), situations during which an increase
in the dose of glucocorticoid is required (26.5%) and the risks of intermittent fasting (2%). Endocrinology specialty and overall medical specialties were
independently associated with a better global score.
Conclusion: physician practice in the management of AI need to be improved.
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References
Bensing S, Hulting AL, Husebye ES, Kämpe O, Løvås K. Management of endocrine disease: Epidemiology, quality of life and complications of primary adrenal insufficiency: a review. Eur J Endocrinol 2016 Sep;175(3):R107-16. doi: 10.1530/EJE-15-1242.
Chabre O, Goichot B, Zenaty D, Bertherat J. Group 1. Epidemiology of primary and secondary adrenal insufficiency: Prevalence and incidence, acute adrenal insufficiency, longterm morbidity and mortality. Ann Endocrinol (Paris) 2017 Dec;78(6):490-494. doi: 10.1016/j.ando.2017.10.010.
Smans LC, Van der Valk ES, Hermus AR, Zelissen PM. Incidence of adrenal crisis in patients with adrenal insufficiency. Clin Endocrinol (Oxf) 2016 Jan;84(1):17-22. doi: 10.1111/cen.12865.
Hahner S. Acute adrenal crisis and mortality in adrenal insufficiency: Still a concern in 2018! Ann Endocrinol (Paris) 2018 Jun;79(3):164-166. doi: 10.1016/j.ando.2018.04.015.
Husebye ES, Pearce SH, Krone NP, Kämpe O. Adrenal insufficiency. Lancet 2021 Feb 13;397(10274):613-629. doi: 10.1016/S0140-6736(21)00136-7.
Guignat L. Therapeutic patient education in adrenal insufficiency. Ann Endocrinol (Paris) 2018 Jun;79(3):167- 173. doi: 10.1016/j.ando.2018.03.002.
Bouziane T, Belmahi N, Salhi H, El Ouahabi H. Knowledge and attitude of patients with adrenal insufficiency. Ann Afr Med 2020 Oct-Dec;19(4):252-257. doi: 10.4103/aam.aam_63_19.
Van Eck JP, Gobbens RJ, Beukers J, Geilvoet W, Van Der Lely AJ, Neggers SJ. Much to be desired in self-management of patients with adrenal insufficiency. Int J Nurs Pract 2016 Feb;22(1):61-9. doi: 10.1111/ijn.12368.
Harsch IA, Schuller A, Hahn EG, Hensen J. Cortisone replacement therapy in endocrine disorders - quality of self-care. J Eval Clin Pract 2010 Jun;16(3):492-8. doi: 10.1111/j.1365-2753.2009.01149.x.
Harbeck B, Brede S, Witt C, Süfke S, Lehnert H, Haas C. Glucocorticoid replacement therapy in adrenal insufficiency- -a challenge to physicians? Endocr J. 2015;62(5):463-8. doi: 10.1507/endocrj.EJ14-0612.
Kampmeyer D, Lehnert H, Moenig H, Haas CS, Harbeck B. A strong need for improving the education of physicians on glucocorticoid replacement treatment in adrenal insufficiency: An interdisciplinary and multicentre evaluation. Eur J Intern Med 2016 Sep;33:e13-5. doi: 10.1016/j.ejim.2016.04.006.
Makin V, Nowacki AS, Colbert CY. A Pilot Assessment of Primary Care Providers’ Knowledge of Adrenal Insufficiency Diagnosis and Management. J Prim Care Community Health 2019;10:1-5. doi:10.1177/2150132719862163
Mazziotti G, Formenti AM, Frara S, Roca E, Mortini P, Berruti A, et al. Management of endocrine disease: Risk of overtreatment in patients with adrenal insufficiency: current and emerging aspects. Eur J Endocrinol 2017 Nov;177(5):R231-R248. doi: 10.1530/EJE-17-0154.
Camozzi V, Betterle C, Frigo AC, Zaccariotto V, Zaninotto M, De Caneva E, et al. Vertebral fractures assessed with dual-energy X-ray absorptiometry in patients with Addison’s disease on glucocorticoid and mineralocorticoid replacement therapy. Endocrine 2018 Feb;59(2):319-329. doi: 10.1007/s12020-017-1380-8.
Chihaoui M, Yazidi M, Chaker F, Belouidhnine M, Kanoun F, Lamine F, et al. Bone Mineral Density in Sheehan’s Syndrome; Prevalence of Low Bone Mass and Associated Factors. J Clin Densitom 2016 Oct;19(4):413-418. doi: 10.1016/j.jocd.2016.02.002.
Hahner S, Loeffler M, Bleicken B, Drechsler C, Milovanovic D, Fassnacht M, et al. Epidemiology of adrenal crisis in chronic adrenal insufficiency: the need for new prevention strategies. Eur J Endocrinol 2010 Mar;162(3):597-602. doi: 10.1530/EJE-09-0884.
Guignat L, Proust-Lemoine E, Reznik Y, Zenaty D. Group 6. Modalities and frequency of monitoring of patients with adrenal insufficiency. Patient education. Ann Endocrinol (Paris) 2017 Dec;78(6):544-558. doi: 10.1016/j. ando.2017.10.009.
Rushworth RL, Torpy DJ, Falhammar H. Adrenal crises: perspectives and research directions. Endocrine 2017 Feb;55(2):336-345. doi: 10.1007/s12020-016-1204-2.
Dineen R, Thompson CJ, Sherlock M. Adrenal crisis: prevention and management in adult patients. Ther Adv Endocrinol Metab 2019 Jun 13;10:2042018819848218. doi: 10.1177/2042018819848218.
Chihaoui M, Chaker F, Yazidi M, Grira W, Ben Amor Z, Rejeb O, et al. Ramadan fasting in patients with adrenal insufficiency. Endocrine. 2017 Jan;55(1):289-295. doi: 10.1007/s12020-016-1186-0.
Chihaoui M, Grira W, Bettaieb J, Yazidi M, Chaker F, Rejeb O, et al. The risk for hypoglycemia during Ramadan fasting in patients with adrenal insufficiency. Nutrition 2018 Jan;45:99- 103. doi: 10.1016/j.nut.2017.07.014.
Chihaoui M, Yazidi M, Oueslati I, Khessairi N, Chaker F. Intermittent fasting in adrenal insufficiency patients: a review and guidelines for practice. Endocrine 2021 Oct;74(1):11-19. doi: 10.1007/s12020-021-02804-z.
