Exp Clin Endocrinol Diabetes 2015; 123 - P09_15
DOI: 10.1055/s-0035-1547708

Poor adherence of patients with chronic adrenal insufficiency to medical advice in daily life

C Walter 1, N Maison 2, F Beuschlein 2, G Meyer 3, K Badenhoop 4, GK Stalla 5, M Quinkler 6, C Schoefl 7
  • 1Division of Endocrinology and Diabetes, Department of Medicine I, University Hospital, Friedrich-Alexander-University Erlangen-Nuremberg
  • 2Medizinische Klinik und Poliklinik IV, Klinikum der Universität München
  • 3Uniklinik Frankfurt, Med. Klinik 1, Endokrinologie
  • 4University Hospital; Internal Medicine & Endocrinology
  • 5Max Planck Institut für Psychiatry; Dept. Internal Medicine, Endocrinol.
  • 6Endocrinology in Charlottenburg, Berlin, Germany
  • 7Division of Endocrinology and Diabetes, Department of Medicine I, University Hospital Erlangen, Friedrich-Alexander University

Introduction: Patients with adrenal insufficiency (AI) require life-long glucocorticoid (GC) replacement therapy. GC treatment needs to be adjusted in response to stressful events and illness in order to prevent life-threatening adrenal crisis (AC). Patients' training should enable them to safely manage their day-to-day life without putting them at risk for AC.

Objectives: To evaluate self-management of patients with AI

Methods: Sixty-eight patients with AI from 5 German centers were assessed at baseline (33 female, 55 ± 15.7yrs, 28 primary AI) and follow-up. Patients were instructed to prospectively document any discomfort, intercurrent illness, or stressful event like surgery as well as changes in GC replacement therapy on a daily basis.

Results: In total 15364 patient days were recorded with equal seasonal distribution. Overall general discomfort, intercurrent illnesses or stressful events were documented on 1863 days (12.1%, range 0 – 88%) with a median of 15 days (range 0 – 162). GC replacement was adjusted on 623 of the 1863 days with general discomfort, intercurrent illness or a stressful event. Individual patients adapted GC replacement in 32% (range 0 – 100) of these days. The increase of GC replacement ranged from 10 – 600% of the daily dose. Intercurrent illnesses or symptoms suggestive for AC were reported on 716 (4.7%) or 269 (1.8%) days, respectively. Individual patients realized GC dose adaptation in 57% (range 0 – 100) or 62% (range 0 – 100) of days with an intercurrent illness or symptoms suggestive for AC, respectively. The corresponding GC dose adjustments ranged from 10 – 600% and from 20 – 600% of the daily GC dose, respectively.

Conclusion: Even in patients treated in specialized endocrine centers adherence to medical advice in daily life is poor. This underscores an urgent need for improved training methods. Keeping daily records might be a useful tool for continued and individualized patient's education.