Effect of Fasting on Adrenal Insufficiency During Ramadan: Patients' Knowledge, Attitude, and Practice

Background Adrenal insufficiency (AI), a condition stemming from adrenal hormone deficiency (primarily cortisol), significantly impacts bodily functions. Ramadan fasting, involving 12-18 hours of daily abstinence, presents serious challenges for individuals with AI, potentially leading to severe health complications. The understanding of AI and its challenges among Saudi Arabian patients remains under-researched. Objective This study assessed the knowledge, attitudes, and fasting practices of AI patients in Saudi Arabia during Ramadan. Methods A cross-sectional survey was conducted (October 15-December 15, 2023) at a tertiary hospital's endocrine outpatient clinic. Patients with AI aged (≥14 years) completed a 33-item structured questionnaire evaluating their understanding of AI, Ramadan fasting practices, and relevant demographic and clinical data. Results Among the 158 participants (predominantly female, 87 (55.1%), and aged 14-20 years, 49 (31%) ), 65 (41.1%) lacked knowledge of AI's primary causes, and 75 (47.5%) felt inadequately informed despite receiving healthcare. While 140 (88.6%) fasted (135 (85.4%) with physician approval), 68 (43%) hadn't discussed fasting plans with providers. Furthermore, 132 (83.5%) were unaware of fasting's implications for their condition, and 75 (47.5%) experienced fatigue. Treatment adjustments were made for 89 (56.3%) during Ramadan, yet many felt unprepared. Conclusion This study reveals substantial knowledge gaps among Saudi Arabian AI patients regarding Ramadan fasting, increasing health risks. Despite widespread willingness to fast, inadequate patient information highlights the urgent need for improved education, provider support, and structured interventions to ensure safe fasting practices.