Neto Leonardo Vieira, Moraes Aline Barbosa, Taboada Giselle Fernandes
Universidade Federal do Rio de Janeiro Hospital Universitário Clementino Fraga Filho Departamento de Clínica Médica Rio de Janeiro RJ Brasil Hospital Universitário Clementino Fraga Filho, Departamento de Clínica Médica, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.
Universidade Federal Fluminense Hospital Universitário Antônio Pedro Departamento de Medicina Clínica Niterói RJ Brasil Hospital Universitário Antônio Pedro, Departamento de Medicina Clínica, Universidade Federal Fluminense, Niterói, RJ, Brasil.
Arch Endocrinol Metab. 2025 Aug 20;69(4):e250098. doi: 10.20945/2359-4292-2025-0098.
To investigate the practices of Brazilian endocrinologists in educating patients with adrenal insufficiency about stress-induced glucocorticoid adjustments.
This was a cross-sectional online survey carried out with 280 endocrinologists across Brazil. The survey included demographic questions and ten clinical vignettes assessing knowledge of appropriate glucocorticoid adjustments during various stressful situations. All participants provided informed consent, and the study protocol was approved by the local Ethics Committee. Statistical analysis compared responses based on physician demographics and practice settings.
The mean percentage of correct answers was 63.3%. A significant proportion of respondents (41.1%) incorrectly believed that patients should not self-administer intramuscular hydrocortisone during an adrenal crisis. Older physicians tended to provide more conservative (and potentially harmful) glucocorticoid dosing recommendations in certain scenarios. Physicians working in both outpatient and hospital settings demonstrated better knowledge of patient education and emergency glucocorticoid administration.
The results of this study revealed moderate adherence to guidelines among Brazilian endocrinologists regarding adrenal insufficiency management and patient education. There is a need for improved education on glucocorticoid self-administration and targeted interventions to address knowledge gaps across different clinical scenarios. Further research is needed to evaluate the impact of these findings on patient outcomes and develop strategies to optimize the management of adrenal insufficiency in Brazil.
调查巴西内分泌科医生对肾上腺功能不全患者进行应激诱导糖皮质激素调整教育的实践情况。
这是一项对巴西各地280名内分泌科医生开展的横断面在线调查。该调查包括人口统计学问题以及十个临床案例，以评估在各种应激情况下适当糖皮质激素调整的知识。所有参与者均提供了知情同意书，研究方案获得当地伦理委员会批准。统计分析根据医生的人口统计学特征和执业环境比较了回答情况。
正确答案的平均百分比为63.3%。相当一部分受访者（41.1%）错误地认为患者在肾上腺危象期间不应自行肌内注射氢化可的松在某些情况下，年长的医生倾向于提供更保守（且可能有害）的糖皮质激素给药建议。在门诊和医院环境中工作的医生对患者教育和紧急糖皮质激素给药表现出更好的了解。
本研究结果显示，巴西内分泌科医生在肾上腺功能不全管理和患者教育方面对指南的遵循程度中等。需要加强关于糖皮质激素自我给药的教育以及有针对性的干预措施，以弥补不同临床场景下的知识差距。需要进一步研究来评估这些发现对患者结局的影响，并制定策略以优化巴西肾上腺功能不全的管理。
