Mofokeng Thabiso R P, Beshyah Salem A, Mahomed Fazleh, Ndlovu Kwazi C Z, Ross Ian L
Department of Medicine, University of the Free State, Bloemfontein, South Africa.
Department of Medicine, Dubai Medical College, Duabi, United Arab Emirates.
Endocr Connect. 2020 May;9(5):445-456. doi: 10.1530/EC-20-0129.
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.
An online survey of physicians' experience relating to PAI.
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.
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.
非洲原发性肾上腺皮质功能减退症（PAI）的负担及管理情况尚无充分记录。我们旨在确定非洲确诊PAI患者的具体疾病特征、患者人口统计学特征及临床管理模式。
对医生关于PAI的经验进行在线调查。
共收到1334份回复，其中589份完整，332名受访者报告曾管理肾上腺功能减退症患者。所描述的回复涉及总计5787例肾上腺功能减退症患者（女性2746例，男性3041例），其中2302例患有PAI。撒哈拉以南非洲（SSA）地区与中东和北非（MENA）地区PAI的可能病因包括自身免疫性疾病（20%对60.3%；P<0.001）、结核病（34%对4.1%；P<0.001）、艾滋病（29.8%对1%；P<0.001）、恶性肿瘤和遗传疾病。16%的PAI患者（376/2302）出现肾上腺危象。SSA地区1233例患者（83.6%）和MENA地区330例患者（40.4%）未采用医疗紧急情况识别（P<0.001）。两个地区诊断检查相对难以获取的情况包括：SSA地区肾上腺抗体检测为63%，MENA地区为69.6%（P = 0.328）；SSA地区血清皮质醇检测为49.4%，MENA地区为26.7%（P = 0.004）；SSA地区血清促肾上腺皮质激素检测为55.7%，MENA地区为53.3%（P = 0.217）；SSA地区肾上腺CT扫描为52.4%，MENA地区为31.8%（P = 0.017）。在整个队列中，氢化可的松的总体使用情况及推测的合成促肾上腺皮质激素使用比例分别为59.4%和50.7%。
通过医疗保健专业人员的认知和实践，我们确定了PAI诊断和管理中的重大挑战，这可能预示着高死亡率。地区差异可能反映了医疗资源的分配情况。
