Knowledge and attitude of patients with adrenal insufficiency

Abstract

Background: Adrenal insufficiency (AI) is a rare and a dangerous disease requiring a life-long glucocorticoid replacement therapy with dose adjustment in stressful situations which is linked to patient's knowledge and understanding. The aim of this study was to explore AI patients understanding regarding their disease, risk factors of adrenal crisis, as well as their attitude in stressful situations. Materials and Methods: We prospectively enrolled from October to January 2017, all patients with adrenal insufficiency (primary or secondary) treated and followed up in the Department of Endocrinology at University Hospital Center Hassan II of Fez. Patients were asked to fill out a questionnaire to assess their self-perceived subjective understanding to objectively evaluate their knowledge. Results: A total of 55 AI patients participated in this study. Overall, 74% of patients had no sufficient understanding of their disease; more participants gave incorrect answers to how to act in different stressful situations. Eleven patients (20%) did not possess a “steroid warning card,” twenty-five patients (45%) had the injectable hydrocortisone (HC) set at home; 40% carried the HC required for the day with them. Globally, the patients self-perceived, subjective knowledge level was not good, a severe lack of knowledge had been identified concerning the knowledge of risk factors of AI. Conclusion: The present study shows the urgent need to develop a structured and continuous education of patients with adrenal insufficiency to improve their self-management of the disease.

Characteristics and Challenges of Primary Adrenal Insufficiency in Africa: A Review of the Literature

“…Our Africa-wide survey [ 9 ] revealed the use of a wide variety of glucocorticoid replacement therapies, including hydrocortisone, prednisone, methylprednisolone, and dexamethasone, depending on availability with a greater range available in the private health system, compared to the public health system (44.0% vs. 17.2%; p < 0.001). In a survey examining the knowledge and attitude of patients with adrenal insufficiency, Bouziane et al [ 82 ] found that 74% of the patients did not have sufficient understanding of their disease and the risks associated with it, including crises precipitated by stress and sickness requiring dose adjustments. In Tunisia, Chihaoui et al [ 83 ] reported that adult Muslim populations in predominantly North African regions who uphold Ramadan have the attendant risk of potentially lethal hypoglycaemic events.…”

Management of adrenal insufficiency

“…[1] The role of the patient in recognizing when an increase in glucocorticoid doses is required is central to minimize the risk to themselves; thus, the importance of patient education is repeatedly emphasized. [2,3] Published existing literature has identified deficiencies in the patients' understanding of steroid sick day rules, [2,4] how to administer parenteral hydrocortisone, [2,4,5] and when to seek medical attention. [2] However, reports highlight gaps in clinician knowledge, particularly on the recognition, and the management of AI.…”

“…[2,3] Published existing literature has identified deficiencies in the patients' understanding of steroid sick day rules, [2,4] how to administer parenteral hydrocortisone, [2,4,5] and when to seek medical attention. [2] However, reports highlight gaps in clinician knowledge, particularly on the recognition, and the management of AI. [4,[6][7][8] Given that healthcare professionals have a central role in patient education, it is essential that clinicians, irrespective of grade are familiar with steroid sick day rules and pharmacokinetics to avoid preventable adverse patient outcomes.…”