Management of adrenal insufficiency: A survey of perceptions and practices of physicians from the Middle East and North Africa

Salem Beshyah; Khawla Ali

doi:10.4103/jdep.jdep_12_21

Journal of Diabetes and Endocrine Practice, Table of Contents

CC BY-NC-ND 4.0 · Journal of Diabetes and Endocrine Practice 2021; 04(03): 125-130
DOI: 10.4103/jdep.jdep_12_21

Original Article

Management of adrenal insufficiency: A survey of perceptions and practices of physicians from the Middle East and North Africa

Salem Beshyah

¹Department of Medicine, Dubai Medical College, Dubai

,

Khawla Ali

²Department of Medicine, Royal College of Surgeons in Ireland Medical University of Bahrain, Busaiteen

› Author Affiliations

Abstract

Introduction: Treatment of adrenal insufficiency (AI) requires correct lifelong use of glucocorticoids (GCs) with early dose adjustments to cover the increased demand in stress to avoid life-threatening emergencies. Objectives: We determine the current specific knowledge of physicians in a convenience sample on the pathophysiological and clinical aspects of AI in the two regions of North Africa and the Middle East. Materials and Methods: Participants (n = 96) were invited to complete an electronic questionnaire with various possible answers on the subject of multiple-choice questions covering physiology, pharmacology, and clinical management and define respondents' professional profiles. Results: The present study suggests that in the investigated settings, physicians' knowledge of physiology and pharmacology GCs, medical replacement strategies in AI, and prevention of adrenal crisis may be insufficient. Great knowledge gaps were demonstrated. Conclusions: There is a need for continuous structured education and training on AI in both general medical and endocrine forums.

Keywords

Adrenal crisis - adrenal insufficiency - glucocorticoid replacement therapy - hydrocortisone - prednisolone

Full Text

References

References
1 Ekman B, Fitts D, Marelli C, Murray RD, Quinkler M, Zelissen PM. European Adrenal Insufficiency Registry (EU-AIR): A comparative observational study of glucocorticoid replacement therapy. BMC Endocr Disord 2014;14:40.
2 Charmandari E, Nicolaides NC, Chrousos GP. Adrenal insufficiency. Lancet 2014;383:2152-67.
3 Allolio B. Extensive expertise in endocrinology. Adrenal crisis. Eur J Endocrinol 2015;172:R115-24.
4 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;162:597-602.
5 Quinkler M, Beuschlein F, Hahner S, Meyer G, Schöfl C, Stalla GK. Adrenal cortical insufficiency – A life threatening illness with multiple etiologies. Dtsch Arztebl Int 2013;110:882-8.
6 Bancos I, Hahner S, Tomlinson J, Arlt W. Diagnosis and management of adrenal insufficiency. Lancet Diabetes Endocrinol 2015;3:216-26.
7 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;22:61-9.
8 Harsch IA, Schuller A, Hahn EG, Hensen J. Cortisone replacement therapy in endocrine disorders-quality of self-care. J Eval Clin Pract 2010;16:492-8.
9 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;62:463-8.
10 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;10:2150132719862163. [doi: 10.1177/2150132719862163].
11 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;33:e13-5.
12 Kampmeyer D, Lehnert H, Moenig H, Haas CS, Harbeck B. Experience pays off! Endocrine centres are essential in the care of patients with adrenal insufficiency. Eur J Intern Med 2016;35:e27-8.
13 Mofokeng TR, Beshyah SA, Mahomed F, Ndlovu KC, Ross IL. Significant barriers to diagnosis and management of adrenal insufficiency in Africa. Endocr Connect 2020;9:445-56.
14 Mofokeng TR, Ndlovu KC, Beshyah SA, Ross IL. Tiered healthcare in South Africa exposes deficiencies in management and more patients with infectious etiology of primary adrenal insufficiency. PLoS One 2020;15:e0241845.
15 Beshyah SA, Sherif IH, Chentli F, Hamrahian A, Khalil AB, Raef H, et al. Management of prolactinomas: A survey of physicians from the Middle East and North Africa. Pituitary 2017;20:231-40.
16 Beshyah SA, Khalil AB, Sherif IH, Benbarka MM, Raza SA, Hussein W, et al. A survey of clinical practice patterns in management of Graves disease in the Middle East and North Africa. Endocr Pract 2017;23:299-308.
17 Ahmad MM, Buhairy B, Al Mousawi F, Al-Shahrani F, Brema I, Al-Dahmani KM, et al. Management of acromegaly: an exploratory survey of physicians from the Middle East and North Africa. Hormones (Athens) 2018;17:373–81. [doi: 10.1007/s42000-018-0045-1].
18 Beshyah SA, Al-Saleh Y, El-Hajj Fuleihan G. Management of osteoporosis in the Middle East and North Africa: A survey of physicians' perceptions and practices. Arch Osteoporos 2019;14:60.
19 Ekhzaimy A, Beshyah SA, Al Dahmani KM, AlMalki MH. Physician' attitudes to growth hormone replacement therapy in adults following pituitary surgery: Results of an online survey. Avicenna J Med 2020;10:215-22.
20 Beshyah SA, Sherif IH, Mustafa HE, Saadi HF. Patterns of clinical management of hypothyroidism in adults: An electronic survey of physicians from the Middle East and Africa. J Diab Endo Practice 2021;4:75-82.
21 Øksnes M, Ross R, Løvås K. Optimal glucocorticoid replacement in adrenal insufficiency. Best Pract Res Clin Endocrinol Metab 2015;29:3-15.
22 Papierska L, Rabijewski M. Delay in diagnosis of adrenal insufficiency is a frequent cause of adrenal crisis. Int J Endocrinol 2013;2013:482370.
23 Bleicken B, Hahner S, Ventz M, Quinkler M. Delayed diagnosis of adrenal insufficiency is common: A cross-sectional study in 216 patients. Am J Med Sci 2010;339:525-31.
24 Pelewicz K, Miśkiewicz P. Glucocorticoid withdrawal – An overview on when and how to diagnose adrenal insufficiency in clinical practice. Diagnostics (Basel) 2021;11:(4):728.
25 Hussain S, Hussain S, Mohammed R, Meeran K, Ghouri N. Fasting with adrenal insufficiency: Practical guidance for healthcare professionals managing patients on steroids during Ramadan. Clin Endocrinol (Oxf) 2020;93:87-96.
26 Beshyah SA, Ali KF, Saadi HF. Management of adrenal insufficiency during Ramadan fasting: A survey of physicians. Endocr Connect 2020;9:804-11.