Endocrine Abstracts

Introduction: Adrenal crises are potentially life-threatening complications in patients with adrenal insufficiency (AI). Our objective was to investigate the frequency of adrenal crises in patients with different forms of AI in the Techniker Krankenkasse (TK), one of the largest German Health Insurance providers, covering more than 12% of the German population.

Design: The Statutory Health Insurance (SHI) database of the TK was analysed for diagnostic codes over an observation period from 01.01.2010 to 31.12.2013. Adjusting data for age and sex, n=11691 diagnoses of AI were recorded and classified in primary (n=4231), respectively secondary (n=7460) AI. Additionally, the subgroup with autoimmune polyglandular syndrome (APS) comprising AI was defined (n=1487). A query for ICD-code E27.2 (adrenal crisis) was performed in these cohorts.

Results: In our cohort, we found a prevalence of 222/million for secondary and 126/million for primary AI. Adrenal crises were documented with a frequency of 4.8/100 patient years. Crises were significantly more frequent in patients with primary (7.6/100 patient years) compared to those with secondary AI (3.2/100 patient years; P<0.0001). Prevalence of crises was higher in individuals with APS comprising primary AI (10.9/100 patient years) and highest in patients with primary AI and type 1 diabetes (12.5/100 patient years).

Conclusions: Applying the SHI database of the TK, comprising more than 8 million individuals, we identified profound data about the risk of adrenal crises in different groups of patients with AI. For the first time our data confirm and extend the clinical observation, that patients with primary AI and additional autoimmune endocrinopathies are at highest risk for adrenal crises. Approximately one of eight patients with primary AI and type 1 diabetes suffers from an adrenal crisis per year. These data provide a basis for specific targeting of efforts aiming at the prevention of adrenal crises.

Disclosure: This work was supported by the European Union 7th framework Health programm FP7 with the acronym EURADRENAL under the grand agreement 2008-201167.