Introduction: Addisons disease (AD) is a rare condition (reported prevalence of 40110 per million) that requires prompt recognition and optimal management to prevent the risks associated with cortisol deficiency.
Aim: To assess the prevalence, presentation and clinical course of patients diagnosed with AD in the geographical area of Banbury in Oxfordshire.
Patients and methods: Notes of subjects with AD currently registered in 15 of the Surgeries in the area of Banbury were reviewed. All cases of AD were found following an exhaustive computer database search of agreed terms by the staff of each Practice.
Results: Amongst a population of 81 225 inhabitants, 15 patients (8 females/7 males) were diagnosed with AD, yielding a prevalence of 185 per million. Median age of diagnosis was 36 years (range 1071). Median time to diagnosis since the first manifestations of the disease was 9 months (range 0.542) and the most frequent ones were tiredness (64.3%) and weight loss (64.3%). At diagnosis, the most frequent manifestations were postural dizziness (85.7%), nausea or vomiting (78.5%) and abdominal pain (57.1%). Adrenal antibodies were identified in 7 (46.7%) patients. Other autoimmunities/endocrinopathies (most commonly thyroid disease and gonadal failure), suggested autoimmune adrenal insufficiency in 10 patients (prevalence of 123 per million). In two cases cause was adrenal hemorrhage, one was diagnosed with haemochromatosis, while in two the cause remained unclear. Median follow up period was 10 years (range 1.846.3). Mean daily hydrocortisone and fludrocortisone replacement dose at last assessment was 22.3 mg and 96.2 μg, respectively. Most frequent complaints on follow up were excessive weight gain (33.3%) and tiredness (33.3%).
Conclusions: Prevalence of AD in Banbury is higher than described in literature and in line with recent reports suggesting rising of its incidence. Alertness on early manifestations can reduce diagnostic delay and risks associated with unrecognized cortisol deficiency.