Stefanie Hahner1, Christina Spinnler, Martin Fassnacht, Stephanie Burger-Stritt, Katharina Lang, Danijela Milovanovic, Felix Beuschlein, Holger S Willenberg, Marcus Quinkler, Bruno Allolio. 1. Endocrinology and Diabetes Unit (S.H., C.S., M.F., S.B.-S., K.L., D.M., B.A.), Department of Medicine I, University Hospital, and Comprehensive Heart Failure Center (S.H., M.F., B.A.), University of Wuerzburg, 97080 Wuerzburg, Germany; Department of Endocrine Research (F.B.), Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität, 80539 Munich, Germany; Division for Specific Endocrinology (H.S.W.), Medical Faculty, University Duesseldorf, 40225 Duesseldorf, Germany; and Clinical Endocrinology Unit (M.Q.), Department of Medicine, Gastroenterology, Hepatology, and Endocrinology, Charité Campus Mitte, Charité University Medicine Berlin, 10117 Berlin, Germany.
Abstract
OBJECTIVE: Adrenal crisis (AC) is a life-threatening complication of adrenal insufficiency (AI), which according to retrospective data represents a significant clinical complication. Here we aimed to prospectively assess incidence of AC and mortality associated with AC in patients with chronic AI. METHODS: A total of 423 patients with AI (primary AI, n = 221; secondary AI, n = 202) were prospectively followed up for 2 years. Baseline assessment included a general questionnaire and detailed written instructions on glucocorticoid dose adaptation during stress. Patients received follow-up questionnaires every 6 months and were contacted by phone in case of reported adrenal crisis. RESULTS: A total of 423 data sets were available for baseline analysis, and 364 patients (86%) completed the whole study. Sixy-four AC in 767.5 patient-years were documented (8.3 crises per 100 patient-years). Precipitating causes were mainly gastrointestinal infection, fever, and emotional stress (20%, respectively) but also other stressful events (eg, major pain, surgery, strenuous physical activity, heat, pregnancy) or unexplained sudden onset of AC (7%) were documented. Patients with a previous AC were at higher risk of crisis (odds ratio 2.85, 95% confidence interval 1.5-5.5, P < .01). However, no further risk factors could be identified. Ten patients died during follow-up; in four cases death was associated with AC (0.5 AC related deaths per 100 patient-years). CONCLUSION: Even in educated patients with chronic adrenal insufficiency, AC occurs in a substantial proportion of cases. Furthermore, we identified AC-associated mortality in approximately 6% of AC. Our findings further emphasize the need for improved management of AC in patients with chronic AI.
OBJECTIVE: Adrenal crisis (AC) is a life-threatening complication of adrenal insufficiency (AI), which according to retrospective data represents a significant clinical complication. Here we aimed to prospectively assess incidence of AC and mortality associated with AC in patients with chronic AI. METHODS: A total of 423 patients with AI (primary AI, n = 221; secondary AI, n = 202) were prospectively followed up for 2 years. Baseline assessment included a general questionnaire and detailed written instructions on glucocorticoid dose adaptation during stress. Patients received follow-up questionnaires every 6 months and were contacted by phone in case of reported adrenal crisis. RESULTS: A total of 423 data sets were available for baseline analysis, and 364 patients (86%) completed the whole study. Sixy-four AC in 767.5 patient-years were documented (8.3 crises per 100 patient-years). Precipitating causes were mainly gastrointestinal infection, fever, and emotional stress (20%, respectively) but also other stressful events (eg, major pain, surgery, strenuous physical activity, heat, pregnancy) or unexplained sudden onset of AC (7%) were documented. Patients with a previous AC were at higher risk of crisis (odds ratio 2.85, 95% confidence interval 1.5-5.5, P < .01). However, no further risk factors could be identified. Ten patients died during follow-up; in four cases death was associated with AC (0.5 AC related deaths per 100 patient-years). CONCLUSION: Even in educated patients with chronic adrenal insufficiency, AC occurs in a substantial proportion of cases. Furthermore, we identified AC-associated mortality in approximately 6% of AC. Our findings further emphasize the need for improved management of AC in patients with chronic AI.
Authors: A M Isidori; G Arnaldi; M Boscaro; A Falorni; C Giordano; R Giordano; R Pivonello; C Pozza; E Sbardella; C Simeoli; C Scaroni; A Lenzi Journal: J Endocrinol Invest Date: 2019-11-26 Impact factor: 4.256
Authors: Christina Bothou; Gurpreet Anand; Dingfeng Li; Tina Kienitz; Khyatisha Seejore; Chiara Simeoli; Andreas Ebbehoj; Emma G Ward; Rosa Maria Paragliola; Rosario Ferrigno; Klaus Badenhoop; Sophie Bensing; Marianne Oksnes; Daniela Esposito; Ragnhildur Bergthorsdottir; William Drake; Jeanette Wahlberg; Nicole Reisch; Stefanie Hahner; Simon Pearce; Peter Trainer; Gwendolin Etzrodt-Walter; Sébastien P Thalmann; Åse B Sævik; Eystein Husebye; Andrea M Isidori; Henrik Falhammar; Gesine Meyer; Salvatore M Corsello; Rosario Pivonello; Robert Murray; Irina Bancos; Marcus Quinkler; Felix Beuschlein Journal: J Clin Endocrinol Metab Date: 2020-08-01 Impact factor: 5.958