Increased morbidity and hospital admissions in patients with adrenal insufficiency
Paul M Stewart1, Beverly MK Biller2, Claudio Marelli3, Candace Gunnarsson4, Michael Ryan4 & Gudmundur Johannsson5
Introduction: Patients with adrenal insufficiency (AI) (primary (PAI), secondary to pituitary disease (PIT) and congenital adrenal hyperplasia (CAH)) have reduced life expectancy with reported standardized mortality ratios of ~2:1 but given the rarity of AI, the underlying explanation remains largely unknown.
Objective: To evaluate patient characteristics, prevalence of concomitant conditions and hospitalization incidence in patients with AI compared to a general population sample.
Methods: Using a US-based national payer database comprising >108 million patients, we used strict inclusion criteria with robust diagnostic codes and pharmacy fill records of steroid prescriptions to identify 10 383 patients with AI; 1014 with PAI, 8818 with PIT and 551 with CAH were followed for >12 months. Patients were matched 1:1 to controls, based on age (±5 years), gender, insurance type and region.
Results: Figure 1 shows steroids used according to AI cohort. Compared with controls, patients with AI had higher odds of diabetes mellitus, hypertension, hyperlipidaemia and depression and anxiety ranging from an OR of 1.51 for hyperlipidaemia in PAI and CAH to 3.85 for diabetes in CAH. The odds of having diabetes (OR=3.85, 95% CI=2.525.90) or anxiety (OR=2.99, 95% CI=2.024.42) were highest in CAH, while depression was highest in the PAI and PIT cohorts (OR=2.40 and 2.55). Hyperlipidaemia and hypertension (OR=1.98 and 2.24) were more common in the PIT cohort versus controls. Inpatient admissions were more frequent in PAI and PIT versus controls; for every 1 control inpatient admission, there were an estimated 4.64 admissions for the PAI cohort (P<0.0001) and 4.00 admissions for the PIT cohort (P<0.0001). Infection was the most common cause for admission.
Conclusion: Using data from >10 000 adults with AI, our study suggests that all types of AI carry a significant metabolic and psychiatric burden, with higher risk of comorbidities and hospital admissions compared to the general population sample.