Endocrine Abstracts

Aims: Recent Endocrine Society Guidelines (2016) suggest establishing the aetiology of primary adrenal insufficiency (PAI) and screening for other autoimmune conditions. The aim of our audit was to compare current practice against these recommendations.

Methods: We identified patients seen in clinic over 18 months between January 2015 and May 2016. The data was collected by reviewing electronic and paper records.

Results: Eighty-three patients (65% females and 35% males) with PAI were identified. The prevalence of PAI (143 per million inhabitants) was similar to other European cohorts. The median age is 52 (19–95 years). The most common co-existing autoimmune disease is hypothyroidism (29%), Type 1 diabetes (16%), vitamin B12 deficiency (8.4%) Grave’s disease and premature ovarian failure (7.2%) and coeliac disease (1.2%). In terms of adrenal antibody testing, there are 60 patients (72%) with positive adrenal antibodies, 13 (15.6%) negative, 4 (4.8%) with unknown antibody status and 6 (7.2%) never tested. Of these 13 patients with negative antibodies, five were females and only one of them had ultrasound. Only one of eight males with negative antibodies was screened for adrenoleukodystrophy which came back negative. Three patients with negative antibodies had CT adrenals. Over the past 5 years all patients had thyroid functions tested, 94% had glucose testing, 98% full blood count, 53% vitamin B12 and 54% screened for coeliac disease.

Conclusions: Our audit showed that only a small proportion (~30%) of antibody negative patients with PAI had secondary workup as per current guidelines. Most patients had relevant screening for associated autoimmune conditions apart from coeliac disease and pernicious anaemia. We have implemented an annual check of full blood count, thyroid functions, glucose along with an enquiry regarding menstrual cycle. Coeliac serology and B12 testing would be done every 5 years.