Endocrine Abstracts

Background: The burden and management of Addison’s disease (AD) in Africa have not been well documented. We aimed to identify specific disease characteristics, patient demographics and patterns of clinical management in established AD in Africa, hypothesizing that deficiencies in diagnosis and management exist.

Methods: An on-line survey of a large pool of medical practitioners’ experience from Africa and Middle East, relating to AD was conducted, using a commercial database.

Results: Respondents: Of the 1334 responses received, 589 provided complete data and of these, 332 respondents confirmed that they manage patients with hypoadrenalism. Patients: Data obtained referred to 5787 patients with hypoadrenalism (2746 females, 3041 males), of whom 2302 had primary hypoadrenalism (AD). The likely causes of AD in sub- Saharan Africa (SSA) vs Middle East North Africa (MENA) 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). Most patients 83.7% presented with typical AD symptoms, however 376 patients (16 %) presented in an Addisonian crisis in both regions. Non-availability of diagnostic tests across both regions included tetracosactide in at least 45.7%, serum cortisol 50.7% adrenal antibodies (64.1%), and adrenal CT scans (49.1%). They were managed using hydrocortisone alone in SSA 588 (39.9%), compared with MENA 780 (94.2%); P < 0.001, whereas fludrocortisone was only available in 36% of the entire cohort. Some form of medical emergency identification was used in only 241 patients in SSA (16.4%) vs 493 (59.6%) MENA patients; P < 0.001.

Conclusions: Significant hurdles in diagnosing AD in Africa include poor availability of tetracosactide by plasma cortisol as a surrogate, adrenal autoantibodies and CT scans of the adrenal glands, all proven diagnostic utility. Fludrocortisone is also poorly available. It is expected that these findings may account for inadequate diagnosis, management of AD with potential fatal consequences.