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 May 2017 - 23 May 2017