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

Abstract

Adrenal insufficiency (AI) comprises a group of rare diseases, including primary AI, secondary AI, and congenital adrenal hyperplasia. [1,2] Glucocorticoid (GC) replacement is the cornerstone therapy in the management of AI, intended to prevent life-threatening complications related to AI and improve the well-being and quality of life in patients with AI.Adrenal crisis is a grave complication of AI, occurring even in subjects on regular GC replacement. The incidence of adrenal crisis is estimated at 5-10 per 100 patient-years, with a mortality of 0.5 per 100 patient-years. [3] The primary trigger identified for the development of adrenal crisis is a delay in increased GC dose in cases of infection. [4,5] Patient education is essential to gain the skills needed to prevent acute impairment of their AI disorder. [6,7] Furthermore, previous findings suggest that the treating physicians are the patients' primary source of information regarding AI (89%). Professional healthcare workers are essential for sharing knowledge and advice regarding the various aspects of managing the disease. [8] However, a debate exists on whether physicians' knowledge regarding AI is sufficient, in part due to the rareness of this endocrine disorder. [9][10][11][12] Significant barriers to diagnosis and management of AI were identified in some developing regions of the world with indicators of tiered healthcare that may expose deficiencies in management. [13,14] Therefore, we aimed to examine AI management's current knowledge and perceptions among a sample of physicians from the Middle East and North Africa (MENA) region and in various specialties. Our long-term goal is to identify critical deficiencies in AI 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.

Doctors' Perceptions of Rare Bone Disorders and X-Linked Hypophosphatemia: A Survey from Africa and the Middle East

“…Consequently, several questions were added to the survey to help define the demographic and professional profiles of the respondents and their practices, similar to our previously published studies. [16][17][18] Summary statistics were prepared for responses to each question. Because not every participant answered all questions, the percentage of respondents providing a given answer was calculated individually for each question, using the number of respondents to that question in the denominator.…”

“…Consequently, several questions were added to the survey to help define the demographic and professional profiles of the respondents and their practices, similar to our previously published studies. 16 17 18…”

“…[13][14][15] Several surveys on the management pattern of common endocrine conditions in the Middle East and Africa (MEA) region have been recently conducted. [16][17][18] In the present study, we wished to scope the awareness and perception of physicians in the MEA region concerning certain genetic and metabolic bone diseases in general and XLH as an example of a condition with both conventional and specific therapy. The principal aim was to provide baseline information/data to direct future education.…”

Clinical practice patterns in the management of thyroid nodules: The first survey from the Middle East and Africa

“…They were identified from databases of health-related bodies, professional groups, and recent continuous professional development events as previously described. [10][11][12][13][14] The initial invitation E-mail explained the rationale of the study. Biweekly reminders were sent for nonresponders and partial responders.…”

“…[9] Additional questions were included to define respondents' demographic and professional profiles and their regional and international affiliations similar to our previous studies. [10][11][12][13][14] A corrective single question was sent to all original respondents to follow the original methodology. A corrective single question was sent to all original respondents to follow the original methodology.…”