adrenal disorders are multifaceted involving genetics , autoimmunity , infection and environmental endocrine influences as the etiological trigger .
it includes various disorders in the form of adrenal insufficiency , cushing syndrome ( cs ) , secondary hypertension ( pheochromocytoma and conn 's syndrome ) , and congenital adrenal hyperplasia ( cah ) which are treatable and have avoidable morbidity and mortality . in india ,
posttubercular adrenalitis leading to insufficiency has been noticed in 46%56% patients and when further investigated the number rose to 70%75% .
increase in the incidence of hiv / aids has also contributed in increasing the number of cases presenting as adrenal insufficiency .
adrenal insufficiency is one of the most common causes of cardiovascular instability leading to shock and death in india .
cortisol deficiency leading to hypotension , shock , and nonreviability of patient is commonly encountered .
the diagnosis and management of primary adrenal insufficiency needs a high degree of suspicion , acumen , knowledge about adrenal disorders , and a protocol - based approach .
cah , an autosomal recessive disorder of defective steroid genesis , is as common as 1/10,0001/20,000 for salt wasting / simple virilizing .
cah and for the milder varieties such as nonclassical cah ( nccah ) , the incidence is 1/1000 cases .
infertility , delayed puberty , and metabolic syndrome are the critical challenges which are associated with cah .
india is at the epoch of socioeconomic transition and diseases such as obesity and polycystic ovarian disease are nowadays very common among young females .
the burden of such adrenal disorders is very high in clinical practice , but the level of awareness is not that high among medical graduates and postgraduates students .
very few studies have been conducted to test the awareness of adrenal disorders among interns and postgraduate students ( general medicine ) .
hence , the present study was conducted with the objective to assess the knowledge and preparedness of the interns and postgraduate students to tackle the adrenal disease .
the present cross - sectional questionnaire - based study was performed on 56 participants of 1 , 2 , and 3 year postgraduate residents of general medicine ( n = 14  3 ) and interns ( n = 14 ) in the department of medicine , gandhi medical college , bhopal , madhya pradesh , among the postgraduate students and interns posted in the department of medicine .
confidentiality of the participants and the data collected were maintained at every step and the data collected were used for study purpose only . after explaining the objective of the study , the questionnaire comprising different multiple choice questions were distributed .
the questionnaire covered a range of questions ( 12 questions in total ) that would test basic knowledge about of the participants on topic such as adrenal insufficiency , adrenal adenoma , cah , nccah , pheochromocytoma , and conn 's syndrome .
no data on age and gender were collected to further protect the individual identity of the participants .
the questionnaire was given to every participant , who answered the questions anonymously and the answers were kept confidential .
the data were analyzed descriptively ( frequency analysis ) by disease type ( primary adrenal insufficiency , cah , nccah , cs , pheochromocytoma , and conn 's syndrome ) , treatment , and dosing regimen .
among the study participants , 14 ( 25% ) participants scored < 5 marks , 33 ( 58.9% ) scored between 6 and 9 , and 9 ( 16.1% ) scored between 10 and 12 [ table 1 ] .
the mean score among the participants was 6.38  2.505 with a range from 2 to 11 marks [ table 2 ] .
total score distribution among responders response to the question in numbers ( 12 question  14 participants in each group=168 responses ) the number of correct answers by postgraduates residents of 1 year was 101 , 2 year was 95 , and 3 year was 93 and interns scored 68 out of total 168 questions in each group [ table 2 ] . mean awareness score for residents of 1 , 2 , and 3 year participants and interns was 7.21  2.806 , 6.79  2.119 , and 6.64  2.818 and 6.63  2.505 , respectively [ table 3 ] .
mean scores of the participants included in the study the residents who answered correctly for adrenal disease - related disorders were 45.5% , ( maximum by 1 year : 52.45% and minimum by interns : 36.9% ) , related to diagnosis were 57.7% ( maximum by 2 year : 69% and minimum by interns : 42.9% ) , and related to treatment were 64.3% ( maximum by 1 and 3 year : 71.4% and minimum by interns 50% ) [ table 4 ] .
percentage awareness among different doctor groups answers to a question regarding how commonly is adrenal insufficiency diagnosed in medical intensive care unit , none of the individuals responded correctly .
awareness score regarding adrenal insufficiency was 47.6% ( maximum by 2 year : 58.3% and minimum by interns : 28.6% ) , treatment for adrenal insufficiency was 40.5% ( maximum by 2 year and minimum by interns : 33.3% ) , cah was 63.4% ( maximum by 1 year : 78.5% ) , pheochromocytoma was 50.9% ( maximum by 1 year : 57.1% ) , conn 's disease was 58.9% ( maximum by 3 year : 78.6% ) , and overall correct response was maximum for cah ( 63.4% ) and minimum for adrenal insufficiency ( 47.6% ) .
endocrine disorders in several million children and adults in india remain undetected and untreated because of inadequate professional expertise and a lack of reliable diagnostic services .
general practitioners and some specialists often fail to suspect endocrine disorders , even in likely cases .
studies have shown that in india , one in every four patients with tuberculosis has adrenal involvement , yet few are investigated for this .
endocrine training in india consists of a brief nonformal exposure during postgraduate training in the form of patients admitted in wards being treated for additional endocrine illnesses , the curriculum of examinations usually does not have cases of diabetes , thyroid , and other endocrine illnesses .
neurology , cardiology , pulmonology , and gastroenterology form the major chunk of postgraduate curriculum in general medicine , where endocrine training is the less sort after .
hence , the responsibility of endocrine training in india is at the superspecialty courses such as dm in endocrinology , dnb training in endocrinology , and post doctoral certificate courses .
there are somewhere around seventy endocrine superspecialty postgraduates who are completing the training every year , i.e. , we are having one newly trained endocrinologist every year to cater a population of roughly 2 million .
the mean score obtained among the study participants was 6.38  2.505 , score ranged from 2 to 11 marks .
this is a clear reflection of the lack of priority , acumen , and awareness of adrenal disorders in our medical teaching curriculum which is actually followed .
when we saw the breakup of correct responses , it was maximum by the 1 year resident , followed by 2 year and 3 year .
this can be explained by the preparation during the postgraduate entrance examinations , which has improved the knowledge among the 1 year residents as compared to interns and later during the 2 and 3 year of residency , the knowledge has declined because of less discussion in clinical rounds , case presentation , and awareness of adrenal disorders during training .
the trend of awareness , diagnosis , and management of adrenal disorders followed the same pattern as the responses given above .
awareness score regarding adrenal insufficiency was 47.6% ( maximum by 2 year : 58.3% and minimum by interns : 28.6% ) , treatment for adrenal insufficiency was 40.5% ( maximum by 2 year and minimum by interns : 33.3% ) , cah was 63.4% ( maximum by 1 year : 78.5% ) , pheochromocytoma was 50.9% ( maximum by 1 year : 57.1% ) , conn 's disease was 58.9% ( maximum by 3 year : 78.6% ) , and overall correct response was maximum for cah ( 63.4% ) and minimum for adrenal insufficiency ( 47.6% ) .
there is a huge responsibility on the medical teaching fraternity for the diagnosis , management , and treatment of adrenal disorders in central india .
seeing to commonality of adrenal - related illnesses and a large number of cases , there should be awareness among the postgraduate students in medicine regarding adrenal - related illnesses .
there are fewer opportunities in terms of number for endocrine - related post - md training in india .
we need to make our postgraduates in medicine well versed with the knowledge of adrenal disorders .
there is a lack of awareness regarding diagnosis , management , and treatment of adrenal disorders in central india .
we need to prioritize training related to these illnesses in our postgraduate teaching curriculum in practice .
 introduction : adrenal disorders could be a life - threatening emergency , hence requires immediate therapeutic management . for this awareness regarding its diagnosis , management , and treatment is prime important.aims and objective : to study the awareness of adrenal disorders among interns and postgraduates students of hamidia hospital , bhopal.materials and methods : a cross - sectional questionnaire - based study was performed . 
 fifty - six participants , i.e. , 1st , 2nd , and 3rd years postgraduate residents of general medicine ( n = 14  3 ) and interns ( n = 14 ) were included in the study . 
 there were 12 questions on adrenal insufficiency , adrenal adenoma , congenital adrenal hyperplasia ( cah ) , nonclassical cah ( nccah ) , pheochromocytoma , and conn 's syndrome . 
 one mark was awarded for each correct response.results:in the present study , 14 ( 25% ) participants scored < 5 marks , 33 ( 58.9% ) scored between 6 and 9 , and 9 ( 16.1% ) scored between 10 and 12 . 
 the mean score among the participants was 6.38  2.505 , with a range from 2 to 11 marks . 
 the number of correct answers by postgraduates residents of 1st year was 101 , 2nd year was 95 , and 3rd year was 93 and interns scored 68 out of total 168 questions in each group . mean awareness score for residents of 1st , 2nd , 3rd years participants and interns was 7.21  2.806 , 6.79  2.119 , and 6.64  2.818 and 6.63  2.505 , respectively . 
 most of the participants recorded correct responses related to diagnosis ( 57.7% ) followed by responses related to treatment ( 64.3% ) . 
 answers to a question regarding how commonly is adrenal insufficiency diagnosed in medical intensive care unit , none of the individuals responded correctly.conclusion:there was a lack of awareness regarding diagnosis , management , and treatment of adrenal disorders in central india . 
 we need to prioritize training related to these illnesses in our postgraduate teaching curriculum in practice . 
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