Survey of oral hydrocortisone utilization in Madrid (Spain)

Abstract

A progressive 69% increase in sales of hydrocortisone tablets was observed in Spain from 1988 to 1995. But there were no data suggesting an increase in the number of adrenal insufficiency cases. We aimed to assess the hydrocortisone prescription habits of physicians in 1996 in Madrid (Spain). An anonymous mail questionnaire was sent to 6130 randomly selected physicians (3345 generalists and 2785 specialists) of Madrid. Five hundred and forty-six questionnaires (8.8%) were returned. Three hundred and eighteen physicians (58.2%) sometimes prescribed oral hydrocortisone. 70.8% of these physicians prescribed hydrocortisone for chronic adrenal insufficiency, 17.3% for acute adrenal insufficiency, 7.9% for congenital adrenal hyperplasia, and 30.2% for inflammatory diseases (asthma, allergic diseases, urticaria, rheumatic diseases, ulcerative colitis). Prescription for inflammatory diseases was more frequent in male physicians, physicians older than 40 years, and general practitioners. We can conclude that the main indication for hydrocortisone prescription was chronic adrenal insufficiency but there was a significant number of physicians that used the drug in inflammatory diseases. As a drastic increase in prevalence of adrenal insufficiency seems unlikely, the augmentation in sales of hydrocortisone could be explained by its prescription for other pathologies.