SAT-453 Challenges in the Diagnosis and Management of Adrenal Insufficiency in ASEAN Countries

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Abstract Disclosure: V. Ramadoss: None. L. Cheong: None. L. Tan: None. P. Limumpornpetch: None. T. Puar: None. P. Eng: None. Objective: Adrenal insufficiency (AI) is a life-threatening endocrine disorder requiring timely diagnosis and management. This study aims to assess the burden, diagnostic approaches and management practices for AI across ASEAN nations, address unmet needs and improve outcomes through regional collaboration. Methods: A prospective, multicentre survey (October 2024–January 2025) was distributed to private and public healthcare providers by the ASEAN Network of Adrenal Hypertension (AnAH). The survey targets physicians managing AI across ten ASEAN countries. Lower-middle- (Indonesia, Philippines, Vietnam, Myanmar, Cambodia), upper-middle- (Malaysia, Thailand), and high-income nations (Singapore and Brunei) countries were included. Results: A total of 132 responses were received, with most from Cambodia (42.4%), Singapore (20.4%), Thailand (19.6%) and Vietnam (19.8%). Respondents were predominantly consultants (73.5%), 66.7% were endocrinologists, and 72.0% worked in public teaching hospitals. Common causes of AI included exogenous glucocorticoid-induced AI (87.1%), secondary AI (54.5%), AI due to infection or metastasis (32.6%), prior unilateral adrenalectomies (15.2%). Reported symptoms were fatigue (92.4%), nausea (59.8%), light-headedness (49.2%), gastrointestinal symptoms (37.9%), and hyperpigmentation (14.4%). Early morning cortisol was the preferred screening test (79.5%), but only 23.5% conducted paired cortisol and ACTH testing. Confirmation methods included a short Synacthen test (59%) or cortisol level (69.7%), while 11.4% relied solely on clinical symptoms.Definitions of AI varied, with 18.2% using a cut-off of <100nmol/L and 21.9% using a cut-off of <400 nmol/L. Hydrocortisone (HC) was the preferred treatment for AI crises, with 60.2% favouring bolus administration followed by divided doses, and 32% using continuous HC infusion. For maintenance, 60.2% prescribed HC (15–20 mg/day) in three doses, and 23.3% used prednisolone. Lack of Synacthen (49.2%) and consensus on diagnostic cut-offs (48.5%) were major barriers.In exogenous steroid-induced AI, 90.2% would wean steroid treatment, with weaning durations varied: 34.9% over 3-6 months, 25.6% over 12 months, 10.1% over 2 years. Only 70.7% of the physicians provided steroid emergency cards, and challenges included lack of educational resources (50%), poor patient understanding (91.7%), low healthcare provider awareness (54.5%). Patient adherence was rated higher for follow-up clinic visits (7/10) than for sick-day steroid dose adjustments (5/10). Conclusion: This study reveals significant variations in diagnosing and managing AI in ASEAN countries. Key gaps include inconsistent diagnostic criteria, limited availability of diagnostic tools, and inadequate patient and healthcare provider education. Addressing these gaps is essential to improving AI outcomes in the region. Presentation: Saturday, July 12, 2025

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