AACE2021-A-1022: Management of Adrenal Insufficiency: Survey of Physicians’ from the Middle East and North Africa

Abstract

Treatment of adrenal insufficiency (AI) requires correct lifelong use of glucocorticoids with early dose adjustments to cover the increased demand in stress to avoid life-threatening emergencies. We aimed to determine physicians' knowledge on the pathophysiological and clinical aspects of AI in the two regions of North Africa and the Middle East. An electronic questionnaire on physiology, pharmacology, and clinical management of AI of 96 participants. Half of the participants were attending physicians, and 44,.2% practiced adult endocrinology. Knowledge of physiology and pharmacology of GC hormones (e.g., normal, daily cortisol production and half-life of hydrocortisone (HC) was variable. Physicians' patterns in prescribing and monitoring the adequacy of glucocorticoid (GC) replacement therapy revealed that the majority (81.3%) identified HC preparations for use in GC replacement therapy, followed by prednisone/prednisolone (46.9%), longer-acting prednisolone formulations (13.5%), and Dexamethasone (13.5%). The most frequently reported sign for GC under-replacement was “nausea” (84.4%), followed by “weight loss” (81.3%), “headaches” (44.8%) and “sleep disturbances” (36.5%). The most frequently reported for GC over-replacement was “high blood pressure” (91.6%), followed closely by “weight gain” (90.5%) and “increased blood glucose” (86.3%). A few, 6.3% and 3.2% of respondents considered “weight loss” and “low blood pressure” as symptoms of GC over-replacement, respectively. The situations most frequently identified as necessary for adjustments of GC dosages were "acute severe disease" (92.7%) and "fever more than 38°C" (79.2%) during acute severe disease, dose increase 2-5-fold by 77.1% of respondents. Strangely, some respondents reported dose reduction or even omission. The majority (80.9%) identified the need for emergency, standby medications for patients with AI. Additionally, 94.7% reported the need to issue an emergency card, and 80.9% reported the need for relative and friends' education regarding AI. When traveling, packing adequate GC preparations would be recommended by 90.5%, emergency card (89.5%), and emergency medications (70.5%). In the investigated settings, physicians’ knowledge of physiology and pharmacology of glucocorticoids, medical replacement strategies in AI, and prevention of adrenal crisis may be insufficient. There is a need for more education and training on AI in both medical and endocrine forums.