Search Results
Search for other papers by Thabiso R P Mofokeng in
Google Scholar
PubMed
Department of Endocrinology, Mediclinic Airport Road Hospital, Abu Dhabi, United Arab Emirates
Search for other papers by Salem A Beshyah in
Google Scholar
PubMed
Search for other papers by Fazleh Mahomed in
Google Scholar
PubMed
Search for other papers by Kwazi C Z Ndlovu in
Google Scholar
PubMed
Search for other papers by Ian L Ross in
Google Scholar
PubMed
Background
The burden and management of primary adrenal insufficiency (PAI) in Africa have not been well documented. We aimed to identify specific disease characteristics, patient demographics, and patterns of clinical management in established PAI in Africa.
Methods
An online survey of physicians’ experience relating to PAI.
Results
There were 1334 responses received, 589 were complete, and 332 respondents reported managing patients with hypoadrenalism. The described responses were related to a calculated pool of 5787 patients with hypoadrenalism (2746 females, 3041 males), of whom 2302 had PAI. The likely causes of PAI in Sub-Saharan Africa (SSA) vs the Middle East and North Africa (MENA) regions included autoimmune disease (20% vs 60.3%; P < 0.001), tuberculosis (34% vs 4.1%; P < 0.001), AIDS (29.8% vs 1%; P < 0.001), malignancy, and genetic conditions. Sixteen percent of AD patients (376/2302) presented in an adrenal crisis. Medical emergency identification was not used by 1233 (83.6%) SSA vs 330 (40.4%) MENA patients (P < 0.001), respectively. Relative non-availability of diagnostic tests across both regions included adrenal antibodies 63% vs 69.6% (P = 0.328), s-cortisol 49.4 % vs 26.7% (P = 0.004), s-ACTH 55.7% vs 53.3% (P = 0.217), and adrenal CT scans 52.4% vs 31.8% (P = 0.017) in the SSA and MENA region, respectively. Across the entire cohort, the overall hydrocortisone use and extrapolated proportion of synacthen use were 59.4% and 50.7%, respectively.
Conclusions
Through the perception and practice of healthcare professionals, we identified significant challenges in the diagnosis and management of PAI which may herald high mortality. Differences between regions may reflect the allocation of healthcare resources.
Search for other papers by Hanna F Nowotny in
Google Scholar
PubMed
Search for other papers by Jillian Bryce in
Google Scholar
PubMed
Search for other papers by Salma R Ali in
Google Scholar
PubMed
Division of Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
Search for other papers by Roberta Giordano in
Google Scholar
PubMed
Search for other papers by Federico Baronio in
Google Scholar
PubMed
Search for other papers by Irina Chifu in
Google Scholar
PubMed
Search for other papers by Lea Tschaidse in
Google Scholar
PubMed
Search for other papers by Martine Cools in
Google Scholar
PubMed
Search for other papers by Erica LT van den Akker in
Google Scholar
PubMed
Department of Endocrinology, Karolinska University Hospital, Stockholm, Sweden
Search for other papers by Henrik Falhammar in
Google Scholar
PubMed
Search for other papers by Natasha M Appelman-Dijkstra in
Google Scholar
PubMed
Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan Italy
Search for other papers by Luca Persani in
Google Scholar
PubMed
Search for other papers by Guglielmo Beccuti in
Google Scholar
PubMed
Search for other papers by Ian L Ross in
Google Scholar
PubMed
Search for other papers by Simona Grozinsky-Glasberg in
Google Scholar
PubMed
Search for other papers by Alberto M Pereira in
Google Scholar
PubMed
Department of Medicine, Haukeland University Hospital, Bergen, Norway
Department of Medicine, Karolinska Institutet, Stockholm, Sweden
Search for other papers by Eystein S Husebye in
Google Scholar
PubMed
Search for other papers by Stefanie Hahner in
Google Scholar
PubMed
Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands
Developmental Endocrinology Research Group, University of Glasgow, Glasgow, United Kingdom
Search for other papers by S Faisal Ahmed in
Google Scholar
PubMed
Search for other papers by Nicole Reisch in
Google Scholar
PubMed
Background
Information on clinical outcomes of coronavirus disease 19 (COVID-19) infection in patients with adrenal disorders is scarce.
Methods
A collaboration between the European Society of Endocrinology (ESE) Rare Disease Committee and European Reference Network on Rare Endocrine Conditions via the European Registries for Rare Endocrine Conditions allowed the collection of data on 64 cases (57 adrenal insufficiency (AI), 7 Cushing’s syndrome) that had been reported by 12 centres in 8 European countries between January 2020 and December 2021.
Results
Of all 64 patients, 23 were males and 41 females (13 of those children) with a median age of 37 and 51 years. In 45/57 (95%) AI cases, COVID-19 infection was confirmed by testing. Primary insufficiency was present in 45/57 patients; 19 were affected by Addison’s disease, 19 by congenital adrenal hyperplasia and 7 by primary AI (PAI) due to other causes. The most relevant comorbidities were hypertension (12%), obesity (n = 14%) and diabetes mellitus (9%). An increase by a median of 2.0 (IQR 1.4) times the daily replacement dose was reported in 42 (74%) patients. Two patients were administered i.m. injection of 100 mg hydrocortisone, and 11/64 were admitted to the hospital. Two patients had to be transferred to the intensive care unit, one with a fatal outcome. Four patients reported persistent SARS-CoV-2 infection, all others complete remission.
Conclusion
This European multicentre questionnaire is the first to collect data on the outcome of COVID-19 infection in patients with adrenal gland disorders. It suggests good clinical outcomes in case of duly dose adjustments and emphasizes the importance of patient education on sick day rules.
