Background: Diagnosis of adrenal hypofunction requires a high index of suspicion. A frequent cause is iatrogenic glucocorticosteroid prescribing hence the need for a clinical review after a prolonged course.
Aim: A review of glucocorticosteroid prescribing and auditing SST outcomes in a large private hospital.
Methods: Electronic records over an 18 month period were analysed for SST results, patient demographics and hospital-wide glucocorticosteroid prescriptions.
Results: Of 585000 recorded hospital visits, 59690 glucocorticosteroid prescriptions were issued with a mean duration of 2.5 weeks (range 1 to 900 days). 929 prescriptions had more than 2 months duration. Most frequent formulation was nasal mometasone, 8412 (14%), mean duration 1.5 weeks (range 1 to 60 days). Oral formulations doses ranged 4 to 20 mg of prednisolone equivalent with mean duration 1.3 weeks (range 1 to 150 days).
68 patients (44 females) had SST for suspected hypoadrenalism. Average systolic BP was 112 (range 80148) mmHg; average BMI was 26 (range 13.2 to 46.7) kg/m2.
SST results were grouped according to cortisol assay times after baseline: group A had cortisol assayed at 30 and 60 minutes (n=31(46%); group B had 30 minute cortisol assay only (n=37(54%). In group A, 5(16%) failed at both 30 and 60 minutes. 11(35%) failed at 30, passing at 60 minutes, 8(26%) had a sub-optimal response at 30, passing at 60 minutes. 7(23%) passed both 30 and 60 minutes. In group B, 10(27%) failed with 4(11%) suboptimal response and 23(62%) passed.
Conclusions: To our knowledge, this is the first such study ever done in UAE. A much higher index of suspicion is required in proportion to longer duration of glucocorticosteroid prescriptions. SST needs standardising and gold standard ITT to be used in unclear cases. Increasing such awareness among non-endocrine prescribers will ensure more patients are promptly diagnosed with adrenal insufficiency.