Influencing factors on quality of life in patients with Addisons disease
G. Meyer, A. Hackemann, M. Penna-Martinez & K. Badenhoop
Introduction: Several previous studies showed a reduced quality of life (QoL) in patients with Addison`s disease, but only few data on the potential influencing factors are available so far.
Methods: We determined current QoL in 200 patients with Addison`s disease using AddiQoL-36, a questionnaire developed in collaboration with the European consortium Euradrenal. Furthermore, data about symptoms, diagnosis and medication were collected by questionnaires and serum concentration of vitamin D 25-OH was measured.
Results: With increasing latency between first symptoms and diagnosis of adrenal insufficiency, QoL decreased highly significant (P=<0.001). Patients diagnosed in the first month after onset of symptoms had a significantly higher QoL compared to patients with a diagnosis delayed more than 12 months (P=0.01). Age at manifestation correlated negatively with QoL (P=0.01). Another important influencing factor was the incidence of additional autoimmunopathies. QoL decreased significantly with increasing autoimmune morbidity (P=0,01). Coeliac disease (P=0.05), atrophic gastritis (P=0.01) and especially primary ovarian failure (P=0.01) were highly correlated with reduced QoL. Vitamin D 25-OH serum level seemed not to be of influence. QoL did not vary significantly between patients with normal (>20 ng/ml), low (<20 ng/ml) or extremely low (<10 ng/ml) vitamin D concentrations.
Conclusions: Quality of life in patients with Addisons disease is impaired significantly in patients with autoimmune polyglandular syndrome and in those with manifestation at higher ages. Latency between first symptoms and diagnosis revealed as the most important factor influencing the patients quality of life even years after manifestation of the disease. Similar results have been seen in another study recently, emphasizing the relevance of this point.
A higher attention for this rare disease and an earlier diagnosis might lead to a sustained improvement of quality of life in Addison patients.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This work was supported, however funding details unavailable.