Knowledge of crisis prevention strategies are highly effective, whereas vulnerability scores may elicit Addison’s disease crises

Abstract

Objective: The knowledge in patients with Addison’s disease (AD) to prevent an adrenal crisis and the degree to which patients feel vulnerable. Design: Telephonic interview of patients with AD in 47 patients, assessing knowledge of prevention of a crisis and vulnerability using a vulnerability scale. Methods: Knowledge of adrenal crisis (AC) and vulnerability score completed. Patients were compared based on having had a crisis or not. Factors associated with AC and the impact of knowledge, vulnerability were determined. Results: (64%) had an adrenal crisis in the previous five years, compared with 34% who never had a crisis. Crisis was associated with poorer knowledge prevention of an AC, especially having a cold (31.2% vs 71%; p=0.002) fever (44.7% vs 90.3%; p<0.001) infection (50% vs 93.5%; p<0.001) vomiting (50% vs 80.6%; p=0.007), and diarrhoea (37.5% vs 71%; p<0.001), respectively. The median proportion with vulnerability for each question was 41.5%. Disease duration was negatively correlated with vulnerability; (r=-0.426, p=0.003). Number of comorbidities was correlated with vulnerability (r=0.290, p=0.048). A negative correlation between knowledge score and number of crises in the previous five years (r=-0.530, p<0.001). Logistic regressions showed the only predictor for a crisis in the past year or past 5 years was patients’ knowledge (p<0.001). Predictors of knowledge were younger patients, more comorbidities, patients who had AC, scored higher on vulnerability questionnaire. Variables accounted for 52% of the variance (F=9.751, p<0.001). Conclusions: Education is critical in preventing AC, specifically cold, fever, infection, vomiting and diarrhoea. Health-care providers should provide psychological support, considering significant vulnerability burden.