Management of adrenal insufficiency during Ramadan fasting: a survey of physicians

Introduction: Appropriate dose adjustments of glucocorticoids replacement therapy for adrenal insufficiency (AI) is vital. Objective: We sought to scope physicians’ perceptions, and practices regarding Ramadan fasting (RF) impact on the management of AI. Methods: A web-based survey of a convenience sample of endocrinologists. Results: Nearly two-thirds of 145 respondents (64.1%) were adult endocr inologists and almost half (49%) saw more than 10 hypoadrenal patients per yea r. Most respondents (78.6%) prescribed hydrocortisone, while the minority prescribed other preparations. The glucocorticoid doses were reportedly divided twice daily by 70.8% and thrice daily by 22.2% of respondents. Respondents recognized RF as having po tential consequences in adrenal insufficiency patients included causing hypoglycaemia, undue tiredness, and fatigue, hypotension, feeling dizzy, and light-headedness. Symptoms of under-replacement were thought to happen in the late afternoon by 59. 3% of respondents. Almost half (45.5%) of respondents thought that RF has some pro bable or definite impact on glucocorticoid therapy that certainly warrants specifi c concern and possible action. Three quarters (76.4%) of respondents confirmed providin g specific management recommendations during RF. The most frequently reported recomme ndation was taking in the usual morning dose of hydrocortisone just before pre-daw n meal (Suhor) (57.8%). A third switch patients from hydrocortisone to prednisolone/pre dnisone. Half reported providing patients with specific recommendations regarding breaking their fast and/or seeking help if hypoadrenal symptoms occur. Conclusions: There is a remarkable variation in the physicians’ perceptions and practices regarding the management of AI during Ramadan. This warrants pr ofessional effort to increase the awareness and dissemination of evidence-based guid elines.

Abstract licence: CC BY-NC

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