Division of Endocrinology, Department of Medicine (University of the Free State), Free State, South Africa.
Division of Nephrology and Hypertension, Department of Medicine (University of Cape Town), Cape Town, South Africa.
PLoS One. 2020 Nov 5;15(11):e0241845. doi: 10.1371/journal.pone.0241845. eCollection 2020.
We wished to determine the prevalence, etiology, presentation, and available management strategies for primary adrenal insufficiency (PAI) in South Africa (SA), hypothesizing a prevalence greater than the described 3.1 per million. There is great inequity in healthcare allocation, as two parallel healthcare systems exist, potentially modifying PAI patients' clinical profiles, private being better resourced than public healthcare.
An online survey of physicians' experience relating to PAI.
The physicians were managing 811 patients, equal to a prevalence of 14.2 per million. Likely causes of PAI in public/ academic vs private settings included: AIDS-related [304 (44.8%) vs 5 (3.8%); p<0.001], tuberculosis [288 (42.5%) vs 8 (6.0%); p<0.001], autoimmune disease [50 (7.4%) vs 88 (66.2%); p<0.001], malignancy [27 (4.0%) vs 7 (5.3%); p = 0.500], genetic including adrenoleukodystrophy (ALD) [5 (0.7%) vs 16 (12.0%); p<0.001], respectively. Overall, more patients presented with nausea [101 (74.3%) and vomiting 89 (65.9%), than diarrhoea 76 (58.9%); p = 0.008 and 126 (15.5%) in adrenal crisis. Features suggestive of a crisis were hypoglycaemia [40 (78.4%) vs 42 (48.8%); p = 0.001], shock [36 (67.9%) vs 31(36.9%); p<0.001], and loss of consciousness [25 (52.1%) vs 27 (32.9%); p = 0.031]. Greater unavailability of antibody testing in the public vs. the private sector [32 (66.7%) vs 30 (32.1%); p = 0.001], [serum-ACTH 25 (52.1%) vs 16 (19.5%); p<0.001] and glucocorticoids were [26 (54.2%) vs 33 (40.2%); p = 0.015]. Many patients, 389(66.7%) were not using identification, indicating that they need steroids in an emergency.
A survey of South African physicians suggests a higher prevalence than previously reported. Patients presented with typical symptoms, and 15.5% presented in adrenal crisis. Significant disparities in the availability of physicians' expertise, diagnostic resources, and management options were noted in the public versus private settings. Greater awareness among health practitioners to timeously diagnose PAI is required to prevent a life-threatening outcome.
我们旨在确定南非（SA）原发性肾上腺功能不全（PAI）的患病率、病因、表现和可用的管理策略，假设患病率高于描述的每百万 3.1 例。由于存在两种并行的医疗保健系统，医疗保健资源的分配存在很大的不平等，这可能会改变 PAI 患者的临床特征，私立医疗保健比公立医疗保健的资源更充足。
对与 PAI 相关的医生经验进行在线调查。
医生共管理了 811 名患者，患病率为 14.2 例/百万。在公立/学术机构和私立机构中，PAI 的可能病因包括：艾滋病相关（304 例 [44.8%] 与 5 例 [3.8%]；p<0.001）、结核病（288 例 [42.5%] 与 8 例 [6.0%]；p<0.001）、自身免疫性疾病（50 例 [7.4%] 与 88 例 [66.2%]；p<0.001）、恶性肿瘤（27 例 [4.0%] 与 7 例 [5.3%]；p = 0.500）、包括肾上腺脑白质营养不良（ALD）在内的遗传疾病（5 例 [0.7%] 与 16 例 [12.0%]；p<0.001）。总体而言，与腹泻（58.9%）相比，恶心（74.3%）和呕吐（65.9%）的患者更多（p = 0.008），在肾上腺危象中，腹泻（15.5%）和呕吐（126 例）的患者更多。提示危机的特征包括低血糖（78.4%）和休克（67.9%）（p = 0.001 和 p<0.001），以及意识丧失（52.1%）和休克（36 例）（p = 0.031）。公立机构比私立机构抗体检测的可用性更低（66.7%）和（32 例）（p = 0.001），血清-ACTH （52.1%）和（25 例）（p<0.001）和糖皮质激素（40.2%）和（33 例）（p = 0.015）。许多患者（66.7%）未使用标识，这表明他们在紧急情况下需要类固醇。
对南非医生的调查表明，患病率高于之前的报告。患者出现典型症状，15.5% 出现肾上腺危象。在公立和私立机构中，医生专业知识、诊断资源和管理选择的可用性存在显著差异。需要提高卫生保健从业者的认识，以便及时诊断 PAI，从而预防危及生命的后果。
