There are limited morbidity data regarding patients with adrenal insufficiency. We undertook a retrospective study to examine the aetiology and frequency of emergency hospital admissions. We identified 69 patients receiving hydrocortisone replacement for adrenal insufficiency. 50 medical records were obtained; 20 patients had primary adrenal failure (including CAH) and 30 patients had ACTH deficiency. All emergency admissions that occurred within the last 10 years were reviewed. Two thirds of patients (33 / 50) did not require hospital admission over the study period (mean follow up of 8.7 years). There were 34 admissions involving 17 patients, equating to a mean of 3.9 admissions / year and a mean admission rate of 0.08 admissions / patient / year, with seemingly higher admission rates for ACTH deficient patients; 0.11 / pt / yr. However, 3 ACTH deficient patients who were elderly with multiple health problems had 16 admissions between them. Excluding these individuals, the admission rate for ACTH deficient patients was 0.05 /pt/yr, similar to that of the primary adrenal failure group; 0.04 /pt/yr. The ACTH deficient patients were older (P<0.02), on lower hydrocortisone doses (P<0.02) and had a shorter duration of adrenal insufficiency (P 0.0005) compared to the primary adrenal failure group. Number of co-morbidities, incidence of hyponatraemia and length of stay did not differ between groups. The majority of admissions were due to infection (septicaemia, gastroenteritis, pneumonia) and cardiovascular disease. Patients that required hospital admission over the study period were older (P=0.03) and had more underlying health problems (P<0.02). There were no significant differences in the hydrocortisone dose or duration of diagnosis between the admitted and not admitted groups. In conclusion, patients with adrenal insufficiency do not require frequent emergency hospitalisation. Those who require admission are significantly older with more co-morbidities.
Declaration of interest: There is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.
Funding: No specific grant from any funding agency in the public, commercial or not-for-profit sector.