Endocrine Abstracts

Introduction: Transition from childhood to adulthood represents a time-period in which adolescents/young adults (AYAs) with chronic illnesses start coping with self-managing their disease, often resulting in poor compliance to follow-up. Indeed, up to 50% of AYAs with common endocrine disorders is lost during the referral to an adult clinic. Transition in Endocrinology is poorly investigated yet, in terms of transition readiness, compliance to therapy, adherence to nutritional advice and quality of life (QoL). According to studies performed in other medical fields, these aspects can represent important determinants of a successful transitional program, thus predicting better disease outcomes.

Methods: In the present cross-sectional study, we consecutively enrolled 37 outpatients referring to a tertiary center with a transition-specific endocrine clinic in the presence of at least one chronic endocrine condition. Epidemiological and clinical data were collected. Moreover, transitional features were investigated through four specific questionnaires analyzing transition readiness (TRAQ), quality of life (KINDL-r), medications’ adherence (MARS-5) and diet habits (KIDMED).

Results: Thirty-seven patients (F/M 23/14, 62%) were consecutively enrolled (age 18.4±2.0 years, min-max 15.3-23.5). Among them, 8/37 were affected by childhood-onset growth hormone deficiency, 3/37 ACTH deficiency, 10/37 hypogonadism, 14/37 hypothyroidism, 28/37 vitamin-D deficiency, 1/37 polycystic ovary syndrome and 1/37 hyperprolactinemia (median disease duration 7 years, IQR 2.7-11). In 19/37 patients was found at least one non-endocrine comorbidity and 4/37 two or more. As far as questionnaires were concerned, median MARS score was 24 (IQR 23-24), KIDMED was 4±3, TRAQ score was 3.7±0.6, and QoL was 0.77±0.15, 0.61±0.15, 0.83±0.13, 0.85 (IQR 0.75-0.95), 0.64±0.11 and 0.85±0.12 for physical, psychological, self-worth, family, friends, functioning and disease-related aspects, respectively. Transition readiness and physical well-being were positively associated with age (P=0.003 and P=0.031, respectively). Moreover, physical, psychological and self-worth QoL were positively associated with male gender (P=0.004, P=0.008 and P=0.002, respectively) while disease-related QoL was negatively associated with the number of endocrine consultations (P=0.012) and positively with the presence of nutritional follow-up (P=0.016).

Conclusions: This represents the first study assessing transition aspects in endocrine conditions. According to our results, transition readiness seems to be age-related. Moreover, males show less concern about the underlying disease, with higher levels of physical and psychosocial well-being and more self-esteem. Attendance at the clinic negatively affects diseases-related QoL, though this could be related to disease severity. Interestingly, nutritional support seems to improve disease burden and perception. Further longitudinal studies are needed in order to identify predictors and determinants of adherence during transition in endocrine diseases.