Objectives: Addisons disease diagnostic and management challenges in Africa are not well documented. We aimed to identify the specific needs of patients with established Addisons disease, across Africa.
Methods: An online survey of a large pool of medical practitioners was undertaken. The questionnaire covered patient demographics, aetiology, therapy and limitations of diagnosis and treatment.
Results: Of the 36,203 recipients; 661 responded; 246 completed the questionnaire. 151 were actively treating Addisons disease. The total number of patients identified with Addisons disease in this study was 1134 (530 males; 604 females). The highest number were reported from South Africa (748; 66%). Majority of patients were in the age groups of 16-60 years with a slight excess of females (334 vs 403). Associations were reported with hypothyroidism in 15.3%, type 1 diabetes in 11.6%, pernicious anaemia in 6.5%, premature ovarian insufficiency in 4.6% and Graves disease in 3.0%. Presentation in crisis was reported in 12.1% of cases, otherwise classical symptoms were seen fairly consistently. Over 60% of patients received hydrocortisone only and the remainder received combination of hydrocortisone and fludrocortisone. Fixed doses of steroid replacement were used by 35.3% of physicians, whereas 57.9% of respondents adjust doses on basis of body weight. Appropriate diagnostic investigations, proved to be the greatest limitation in making the diagnosis, with 73.2% of responders relying on the combination of clinical grounds and compatible electrolytes alone and only 27.9% having access to an ACTH stimulation test. There were few therapeutic options available to the responders outside of South Africa, with overall, 53% indicating non-availability of medication and 58% not having access to a CT scan.
Conclusions: This first continent-wide survey highlighted some challenges in diagnosis and treatment of Addisons disease. Awareness and resources are required for timely recognition and optimal management of Addisons disease in Africa.
20 - 23 May 2017
European Society of Endocrinology