A new patient leaflet for people living with adrenal insufficiency who are thinking about fasting for Ramadan has been produced. It gives tips on reducing the risks of becoming ill if you decide to fast, when it's advisable not to fast and offers alternatives to those who are considered too high risk for fasting.

We speak with Doctor Shazia Hussain, Endocrinology and Diabetes Specialist Registrar, one of the researchers behind this new leaflet, to learn more. She also shares how she worked with us here at the ADSHG, alongside fellow patient support charities The Pituitary Foundation and CAH Support Group, to translate her research paper into a Society of Endocrinology endorsed patient leaflet.

The Qur'an requires Muslims to fast during the month of Ramadan from sunrise to sunset. However, there are exceptions to this. One of them is that people who are ill or have medical conditions do not have to fast. This includes people with adrenal insufficiency, as omission or a delay in administration of steroids can result in life-threatening consequences from an adrenal crisis. 

If you know someone who can’t access this page but would find this leaflet helpful, please print off the leaflet to share with them or Contact Us and we can post a physical copy of the leaflet to you.

Adrenal insufficiency during Ramadan

Research Facts:

• Research paper title: "Fasting with adrenal insufficiency – guidance for patients on long-term steroids who wish to fast during Ramadan."
• Researchers: Sufyan Hussain, Shazia Hussain, Ruzwan Mohammed, Karim Meeran, Nazim Ghouri.
• Patient leaflet endorsed by: Society for Endocrinology, Addison's Disease Self-Help Group (ADSHG), The Pituitary Foundation and CAH Support Group.

What are the aims of this research?

Guidance on how to observe Ramadan safely if you have adrenal insufficiency (AI) is lacking. The aim of this work is to raise awareness amongst patients with AI and encourage them to discuss their intention to fast with their doctor. We hope this will ensure they are supported appropriately and safely through Ramadan. This guidance also aims to provide answers to commonly asked questions many of these individuals are likely to have and we hope will be an easily accessible ‘quick reference’ tool.

Why is this research important for people with Addison’s disease and adrenal insufficiency?

Observing Ramadan can be challenging even in the absence of co-existing health conditions. It is crucial that patients with adrenal insufficiency partaking in religious fasting are well-informed about the importance of taking their steroids during Ramadan, how their dosing or preparation may be changed to support fasting and what actions they should take if they feel unwell whilst fasting. This guidance really focuses on keeping these individuals safe and offers alternatives to those who are considered too high risk for fasting.

“Meet the Researcher” 

Welcome Shazia Hussain! Please share with us more about the background of the project and how you got involved in this research?

I was asked to get involved in this project by the Society for Endocrinology (SfE) clinical committee. My fellow (more experienced) co-authors were keen to write guidance for healthcare professionals caring for patients with adrenal insufficiency (AI) who observe Ramadan as there is surprisingly limited published literature in this field. As an endocrinology trainee and someone who observes Ramadan it made perfect sense to get involved. Whilst we were writing the guidance, we felt it was equally important to have something available for patients with AI too and sought support from the SfE, ADSHG, CAH support group and Pituitary Foundation – all of whom have had a huge role in the production of this leaflet.

"As a group of clinicians, we hope that the combined approach of producing healthcare worker and patient guidance improves understanding of the management of adrenal insufficiency during Ramadan and leads to better patient experiences."

What is your current role and what drives your passion to improve guidance for people living with adrenal insufficiency?

I am a Specialist Registrar in Endocrinology and Diabetes working in London. I currently work for Barts Health NHS Trust and spend most of my working week at the Royal London Hospital.

I have been very lucky to have worked with some incredibly inspiring and accomplished senior colleagues who have had a huge role in contributing towards my training. I am motivated to provide high-quality patient care and am always looking to get involved in new opportunities that will result in improved patient outcomes.

Tell us a bit about your own background?

I graduated from UCL Medical School in 2009 and have done the bulk of my post-graduate training in London. I started my higher specialist training as an Endocrinology and Diabetes Specialist Registrar (SpR) in 2013 on the North East London rotation and have worked in a range of tertiary, teaching and district general hospitals.

In 2016 I took some time out of my training programme to pursue my interest in medical education and leadership. I completed a teaching fellowship, MSc in Medical Education (RCP/UCL) and spent a year working as the RCP Chief Registrar at St Bartholomew’s hospital.

I returned to full-time clinical medicine in September 2019 and am on track to complete my training this year!

Alongside my training, I have worked closely with the SfE as a member of the early career steering group, a SpR representative on the clinical committee and am a leadership and development awards programme awardee – all of which I have really enjoyed and have helped me get involved in some very exciting work.

Outside of work, I enjoy spending time with my family, travelling and learning new skills!

What are your research highlights to date?

I believe in learning through sharing experiences and have presented work at regional, national and international meetings. I am particularly pleased with the varied quality improvement work I have been involved with in recent years and have a growing portfolio of abstracts and publications.

I have, of course, really enjoyed working with colleagues, patients and patient support groups on this particular project and hope I can continue to do similar work in the future.

What are your plans for the future?

I am currently approaching the end of my time as a specialist registrar and am excited about the challenges my next role as a consultant will bring. As well as providing direct clinical care, I have a strong interest in medical education, leadership and quality improvement and hope my future roles will encompass all of this!  

Do you have any advice that you would give to healthcare professionals looking to undertake research to create patient resources?

Definitely get involved! Creating patient resources is a great opportunity to really get a feel for what is important to patients and allows you to influence clinical care on a much larger scale.

"I’ve learnt so much by working with the ADSHG, CAH support group and the Pituitary Foundation and have a greater understanding of the amazing work they do. Getting direct feedback from patients has been extremely insightful and I strongly believe this experience has made me a better clinician."

If creating patient resources is something you’re keen to get involved with then I would suggest you work with a group of equally driven healthcare workers and involve patient support groups and organisations like the SfE who have a wealth of knowledge and experience that will make the process immensely fulfilling and fun!

Thank you Shazia Hussain for speaking and including the ADSHG in the production of this leaflet! We would also like to thank your joint first author Sufyan Hussain and senior authors Karim Meeran and Nazim Ghouri for their hard work to make this research possible.

We would also like to thank the patient volunteers who reviewed and provided feedback on this leaflet, your feedback was invaluable to the production of this fantastic new resource.

Where can I find out more information? The production of this leaflet was funded by the ADSHG, The Pituitary Foundation and CAH Support Group.  Click here to download the Fasting with Adrenal Insufficiency leaflet. If you know someone who can’t access this page or print off the leaflet, please Contact Us and we can post a physical copy of the leaflet to you. If you are a healthcare professional and would like copies for your hospital, please Contact Us so this can be arranged.

ADSHG funds vital research projects aimed at improving the diagnosis and care that people with Addison's and adrenal insufficiency receive through our annual research grants.

Our Research Grant Awards are now open!

Read more about ADSHG grants and how to apply

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