A Questionnaire Based Study on the Knowledge and Practice of Stress Steroid Dosing Protocol among Patients with Adrenal Insufficiency at a Tertiary Care Hospital in India.

Abstract

Introduction: Acute adrenal insufficiency or adrenal crisis (AC) has a mortality rate of 0.5 / 100 patient-years and is a major cause of death in patients with adrenal insufficiency (AI). Non-compliance to steroids and inadequate stress dosing of glucocorticoids can precipitate AC in subjects with AI. In this study we tried to assess the knowledge pertaining to the disease, stress dosing and practice among individuals with AI.

Methods: Ninety-two subjects diagnosed with AI and visiting Endocrinology Outpatient Department (OPD) were subjected to a structured researcher administered questionnaire including questions on knowledge about the disease, symptoms of AI, stress dosing, and practice with respect to cortisol replacement therapy (CRT).

Results: Of the 92 participants, 13% were ignorant of the symptoms of AC, while about 78.2% of the entrants were aware that the dose of glucocorticoid must be doubled during illness. Around 20.7% of the subjects had intermittently stopped therapy on their own, while 13% partakers had failed to increase dose of glucocorticoid during illness. Hospitalization for AC was seen in 18.5% of entrants since the initial diagnosis of AI, with the most common precipitating cause being infection (70.6%).

Conclusion: There were lacunae in the knowledge about AC, CRT and stress dosing of glucocorticoids, and self-care among a significant number of patients with AI despite prior patient education. Hence, it is pertinent to reassess the knowledge, educate and reinforce good practices at multiple follow up visits to prevent AC and improve quality of life in individuals with AI.