ESPE2022 Poster Category 1 Sex Differentiation, Gonads and Gynaecology, and Sex Endocrinology (56 abstracts)
Introduction: The reported occurrence and management of acute adrenal insufficiency (AI) – related adverse events (AE) vary widely between centres and may depend on available resources.
Aim: To use the data within the I-CAH Registry to understand the association between the occurrence and management of AI related AE, their management and the availability of local resources.
Methods: Of the 32 I-CAH centres that reported on the occurrence of SDE (https://home.i-dsd.org/i-cah-registry-care-quality-report/), 24 completed a health care survey of local resources and clinical management with one point assigned for each resource. This included 16 centres from high income countries (HIC) and 8 from low/middle income countries (LMIC). Real world data from these 24 centres (420 children) were linked to the results of the health care survey from the centre.
Results: The median reported rate of sick day episodes (SDE, per patient year per centre) at HIC and LMIC centres was 0.75 (range, 0, 6) and 0.11 (0, 0.49), respectively, (P<0.05). Although, the availability of resources for management of AI – related AE was numerically greater at HIC centres vs LMIC centres with a median score of 5.5 (1,7) and 3.5 (2, 6), respectively, this did not reach statistical significance. The resources included written plans (100% of HIC vs 75% of LMIC), steroid emergency plans (87% of HIC vs 63% of LMIC, and family support events (38% of HIC vs 25% of LMIC). On the other hand, provision of contact details of medical and nursing team was reported more often in LMIC (75% of HIC vs 88% of LMIC). There was no relationship between the availability of resources and the rate of SDE in LMIC or HIC centres. The use of double dose hydrocortisone was reported more frequently in LMIC vs HIC centres (50% vs 31%). For management of adrenal crises, use of parenteral hydrocortisone was reported in 100% of HIC vs 63% of LMIC. On the other hand, the following were reported to be used more frequently in LMIC centres: prednisolone (LMIC:HIC - 38%:19%); glucagon (LMIC:HIC - 25%:13%); admission duration of 3 days (LMIC:HIC - 88%:25%).
Conclusions: Clear differences exist between the occurrence, prevention and management of acute AI–related AE in HIC and LMIC centres. The report of higher SDE rates in HIC than LMIC centres and the lack of a clear association at all centres between the level of resources available and the rate of SDE needs further study.
15 Sep 2022 - 17 Sep 2022