Endocrine Abstracts

Adrenal crisis (AC) is an acute life-threatening emergency contributing to excess mortality in patients with autoimmune adrenal insufficiency (AAI). Clinical, demographic and educational factors associated with high rates of AC admission remain unclear. We therefore examined the long-term clinical course of 91 patients with AAI.

Methods: A retrospective observational study of 91 patients with AAI was performed. Electronic health records (Trakcare systems US), laboratory data and national death and deprivation repositories were linked. Patient questionnaire was performed examining emergency injectable glucocorticoid availability, Sick Day Rule (SDR) delivery and understanding. Poisson regression modelling (R version 4.22) was performed to examine explanatory variables against admission rate for infection, collapse and AC.

Results: Median follow-up was 13.5 years (IQR 9.6–15.2). Increasing deprivation, lower clinic sodium (IRR 0.93; 0.88–0.98/mmol) and fludrocortisone dose (IRR 1.46; 1.25–1.70/50mg) were strongly, independently associated with rate of hospital admission (P<0.05). 88 patients completed a questionnaire. 67(76%) had access to emergency intramuscular hydrocortisone, this was only within use-by date in 57(64%) and only carried regularly by 21(24%). Knowledge of SDRs was variable; 69/88(78%) correctly treated minor illness and only 36/82(43%) correctly treated severe illness. Patients who recalled SDRs from their endocrine appointment had a significantly lower incidence of admission (IRR 0.72; 0.54-0.95 P<0.05).

Conclusion: Chronic hyponatraemia and higher adrenal replacement therapy doses at clinic review are associated with a higher risk of hospital admission risk while SDR delivery was associated with a reduced risk. Expanding delivery and understanding of SDRs as well as encouraging treatment concordance may reduce risk of hospital admission.