Ramadan fasting in patients with adrenal insufficiency

Chihaoui, Mélika; Chaker, Fatma; Yazidi, Mériem; Grira, W.; Amor, Zohra Ben; Rejeb, Ons; Slimane, H.

doi:10.1007/s12020-016-1186-0

Cited by 17 publications

(10 citation statements)

References 25 publications

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“…AI patients should be instructed to hydrate well during non-fasting periods, maintain normal salt intake, and avoid strenuous activities during fasting. The pre-dawn meal, or Suhor, should be rich in complex carbohydrates, healthy proteins, and fats, and should be delayed to right before fasting starts (25). Additionally, all patients should be instructed to carry a steroid emergency card and a medical alert bracelet at all times.…”

Section: Discussionmentioning

confidence: 99%

“…AI patients should always be supplied with i.m. glucocorticoid preparations for self-injection in the event of severe illness, trauma, or persistent vomiting, and advised to go to the hospital after the emergency injection ( 25 ). In our study, only half reported providing patients with specific recommendations regarding breaking their fast and/or seeking help when hypoadrenal symptoms occur, the latter of which may subject AI patients to unforeseen risks and preventable dangers.…”

Section: Discussionmentioning

confidence: 99%

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

Beshyah

Ali

Saadi

2020

Endocrine Connections

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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 endocrinologists and almost half (49%) saw more than 10 hypoadrenal patients per year. 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 potential 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 probable or definite impact on glucocorticoid therapy that certainly warrants specific concern and possible action. Three quarters (76.4%) of respondents confirmed providing specific management recommendations during RF. The most frequently reported recommendation was taking in the usual morning dose of hydrocortisone just before pre-dawn meal (Suhor) (57.8%). A third switch patients from hydrocortisone to prednisolone/prednisone. 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 professional effort to increase the awareness and dissemination of evidence-based guidelines.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Beshyah

Ali

Saadi

2020

Endocrine Connections

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“…[12][13][14] In Islamic culture, patients with adrenal insufficiency can suffer from hypoglycemia during Ramadan fasting, despite the continuance of glucocorticoid replacement therapy. 15 These reports indicate adrenalinsufficient adults are also prone to hypoglycemia, especially during fasting, and that the frequency may have been underestimated. For an early diagnosis, adrenal insufficiency must be considered if hypoglycemia due to an uncertain etiology is observed.…”

Section: Discussionmentioning

confidence: 99%

<p>A Single Episode of Hypoglycemia as a Possible Early Warning Sign of Adrenal Insufficiency</p>

Tanaka

Abe

Kohno

et al. 2020

TCRM

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A 65-year-old woman without a history of diabetes mellitus was admitted for elective total knee arthroplasty for osteoarthrosis. There were no specific complaints except for knee flexion contractures, and the results of preoperative tests were unremarkable. On the day of surgery, the patient suffered from a hypoglycemic attack (52 mg/dL) after preoperative overnight fasting. A dextrose infusion immediately corrected the hypoglycemia, and a total knee arthroplasty was then performed. Although a hypoglycemic attack did not recur, further evaluation was required because of nausea that persisted after surgery. The morning serum cortisol level was 0.15 µg/dL with undetectable adrenocorticotropic hormone (ACTH), and the insulin-like growth factor-1 level was 9 ng/mL. An empty sella and bilateral adrenal atrophy were evident in imaging studies. ACTH and growth hormone (GH) did not respond to testing with corticotropin-releasing hormone and GH-releasing peptide-2, respectively. While serum cortisol did not increase on a rapid ACTH stimulation test, urinary free cortisol excretion responded to a prolonged ACTH stimulation test. Finally, the patient was diagnosed as having empty sella syndrome with ACTH and GH deficiencies. After the administration of hydrocortisone as maintenance replacement therapy, the patient's prolonged postoperative nausea disappeared. Adrenal insufficiency is latent in patients with hypoglycemia episodes. Because patients with adrenal insufficiency require appropriate perioperative corticosteroid supplementation, clinicians should give priority to identifying the underlying etiology of hypoglycemia over non-urgent elective surgery when these co-occur.

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“…The risks of fasting were evaluated in 180 hypoadrenal patients. [40] Of these, 138 were advised by their physicians not to fast and but 91 patients (50.5%) tried to fast. Complications occurred in two-thirds of the patients including asthenia, symptoms of dehydration, intense thirst, and symptoms of hypoglycemia in decreasing frequencies.…”

Section: Endocrine and Metabolic Disordersmentioning

confidence: 99%

The year in ramadan fasting research (2017): A narrative review

Beshyah

Hajjaji

Ibrahim

et al. 2018

Ibnosina Journal of Medicine and Biomedical Sciences

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Ramadan fasting is one of the five Pillars of Islam. While there are several exemptions from fasting, many Muslims with medical conditions still choose to fast. This may adversely affect their health if not addressed properly. Recently, there has been an increased interest in the health implications of Ramadan fasting. The authors performed a narrative, nonsystematic review of the literature including case reports, case series, and review articles indexed in PubMed and Google Scholar in a full calendar year. All records were reviewed by two coauthors at least. Studies were reviewed, summarized, and represented to provide a readily comprehensible concise account of the contributions made to research and clinical practice in 1 year (January–December 2017). The publications spanned physiological and clinical aspects and crossed conventional disciplinary lines in various languages, locations, and systems of journal access. A total of 92 and 82 were found in the PubMed and Google Scholar databases, respectively. Diabetes, hypoglycemia, insulin, and body composition were among the most relevant issues addressed this year. Discipline wise, diabetes, physiology, gastrointestinal, cardiovascular, eyes, respiratory, nephrology, neuropsychiatry, and endocrinology were most prominent. Other articles have considered professional competence, education, ethics, culture, and organization of care. Many of the research groups are based in emerging countries with Muslim-majority, but the publications are still widely distributed in internationally recognized journals. Several workers seem to have Ramadan fast at the center of their academic interest inferred from the number of publications to which they have contributed. The authors hope this review will help direct further research and should inform clinical practice guidance.

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Ramadan fasting in patients with adrenal insufficiency

Abstract: In patients with adrenal insufficiency, fasting can cause complications especially if the level of knowledge about the disease is low.

Cited by 17 publications

References 25 publications

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

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

<p>A Single Episode of Hypoglycemia as a Possible Early Warning Sign of Adrenal Insufficiency</p>

The year in ramadan fasting research (2017): A narrative review

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