A recent study has reported impaired subjective health status (SHS) in 79 patients with primary adrenal insufficiency (AI) despite routine steroid replacement1. Here we have performed a survey in a large cohort of patients with primary and secondary AI. 348 patients (148 outpatients and 200 registered participants of the self-help network for adrenal and pituitary diseases) were contacted by mail. 256 (74%) agreed to participate and received a disease specific and 3 standardized questionnaires (SF-36, GBB24, HADS) assessing SHS. 216 completed sets (primary AI n=137; secondary AI n=79) were available for analysis. SHS was significantly impaired in AI compared to age- and sex-matched controls from a representative random sample of the general German population (n=20767124, for respective questionnaires). AI patients had significantly lower scores in 7 of 8 SF-36 dimensions (all P<0.001). Interestingly, scores for bodily pain were higher in patients with AI (74.2±29.5 vs 65.4±26.3; P<0.001), indicating lower subjective pain perception. Similar to SF-36, GBB24-scores indicated significant impairment of well-being (e.g. global score: 26±16 vs 15±13; P<0.001). Anxiety and depression as assessed by HADS were also higher in AI (anxiety: 6.6±4.1 vs 4.4±3.1, depression: 5.2±4.1 vs 4.2±3.5; P<0.001). 57 patients receiving DHEA also had similarly significant impairment in SHS. In patients with secondary AI, SHS was not significantly more reduced than in patients with primary AI. To better define the impact of AI per se further subgroup analysis was perfomed, which revealed that SHS in isolated Addisons disease and APS was similarly impaired. In conclusion, health-related quality of life is significantly impaired in both primary and secondary AI, which holds true independent from contributing factors such as polyendocrinopathy. Failure of DHEA to fully restore well-being in the subgroup of patients with DHEA indicates the need of further improvement of glucocorticoid replacement strategies.
1. Lovas et al, 2002.
01 - 05 Apr 2006
European Society of Endocrinology