Endocrine Abstracts (2017) 49 EP1029 | DOI: 10.1530/endoabs.49.EP1029

Adherence to hormone replacement therapy in patients with hyp-opituitarism using the Morisky 4-item scale: results of a pilot, prospective, cross-sectional study

Cesar Boguszewski, Simone Abe, Bruna Barbosa, Claudia Biondo, Debora Takito, Kamila Santos, Sayuri Hayashi & Victor Amarilla


SEMPR (Endocrine Division), Department of Internal Medicine, Federal University of Parana, Curitiba, Brazil.


Objective: To investigate adherence to hormone replacement therapy (HRT) in patients with hypopituitarism in a tertiary center outpatient clinic.

Patients and methods: Prospective, cross-sectional study of patients with hypopituitarism on HRT for at least two pituitary deficiencies (independent of diabetes insipidus). Medication adherence was assessed using a validated Portuguese version of four-item Morisky scale, in which participants were asked to indicate the extent to which they agreed with each of 4 statements (two related to unintentional and two with intentional nonadherence) by rating on a 4-point scale (strongly agree, agree, disagree, strongly disagree). Patients were categorized as nonadherent if they indicated agreement (ie, reported either ‘strongly agree’ or ‘agree’) to either item of the subscale. Potential co-variables associated with adherence were tested.

Results: Ninety consecutive patients completed the survey, but five were excluded because they were on HRT with a single hormone. Of the remaining 85 patients (47 men, age 48±16 year), 31 were on HRT with two hormones, 32 with three, 18 with four and 4 with five. Levothyroxine, glucocorticoids, sex steroids, growth hormone and desmopressin were prescribed to 81, 66, 64, 8 and 21 patients, respectively. Mean number of prescribed medications (excluding HRT) per patient was 3.1 (S.D. 2.4; range 0–9). The etiology of the hypopituitarism was non-functioning pituitary tumors (n=19), functioning pituitary tumors (n=17), craniopharyngeomas (n=13), other tumors (n=3), congenital (n=14), vascular (n=13), trauma (n=2), and idiopathic (n=4). Fifty-six (65.9%) patients reported unintentional nonadherence, while only 9 (10.6%) reported intentional nonadherence. Complete adherence was reported by 29.4% of the patients, while 5.9% showed both unintentional and intentional nonadherence. There were no associations of adherence to gender, age, number of pituitary deficiencies and prescribed medications.

Conclusion: Self-reported unintentional nonadherence to HRT is a common finding in patients receiving HRT for hypopituitarism.

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