Clinical audit concerning the quality of management in patients with classic form of congenital adrenal hyperplasia.
OBJECTIVE
High Authority for Health (HAS) edited in April 2011 a national program of care and diagnostic (PNDS) concerning congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency in agreement with the international recommendation 2002 and 2010. To reduce long-term complications and improve the quality of life to our patients, we had tested our professional practices.


METHODS
All patients aged more than 18 years with classic CAH of the adult endocrine units in the Nancy's University Hospital Center.


METHODS
We have made a clinical audit. We checked all medical records to see whether the recommendation were applied or not between the last consultation before (Tour 1; T1) and after (Tour 2; T2) the introduction of the national guidelines.


RESULTS
Twenty-seven medicals records with classic CAH were analyzed. The collection of clinical data must be more systematic because if the weight appeared in 89% of cases, body mass index missed (26% only in T1), the measure of the blood pressure remained insufficient (74% in T2). Concerning the therapeutic balance, 17-hydroxyprogestérone, testosterone, renin were correctly prescribed (>80%), Delta4-androstènedione in improvement (from 67% to 100%) some in defect (stable with 68% sodium and potassium). The evaluation of the fertility considerably progressed on the other hand the markers of bone metabolism were still often too much lacking.


CONCLUSIONS
Change in compliance since national guidelines is a slow process.
Service d'endocrinologie adulte, CHU Brabois, 11, rue du morvan, 54500 Vandœuvre-lès-Nancy, France. ccilejanin1@yahoo.fr
Cécile
C
Janin
Véronique
V
Pascal Vigneron
Georges
G
Weryha
Bruno
B
Leheup
D000293:Adolescent; D000312:Adrenal Hyperplasia, Congenital / Q000453:epidemiology / Q000628:therapy*; D000328:Adult; D002648:Child; D002675:Child, Preschool; D054869:Clinical Audit; D003266:Continuity of Patient Care / Q000592:standards; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D011787:Quality of Health Care; D012189:Retrospective Studies; D055815:Young Adult