Incidence and features of adrenal crisis in patients with Addison

Alberto Scala; Marianna Torchio; Fabio Presotto; Caterina Mian; Filippo Ceccato; Scaroni Carla; Corrado Betterle; Chiara Sabbadin

doi:10.1530/endoabs.99.EP315

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Endocrine Abstracts (2024) 99 EP315 | DOI: 10.1530/endoabs.99.EP315

ECE2024 Eposter Presentations Adrenal and Cardiovascular Endocrinology (155 abstracts)

Incidence and features of adrenal crisis in patients with Addison’s Disease

Alberto Scala ¹ , Marianna Torchio ¹ , Fabio Presotto ² , Caterina Mian ¹ , Filippo Ceccato ¹ , Scaroni Carla ¹ , Corrado Betterle ¹ & Chiara Sabbadin ¹

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¹University Hospital of Padua, Endocrine Unit, Padua, Italy; ²Ospedale Dell’Angelo, Unit of Internal Medicine, Mestre-Venice, Italy

Introduction: Adrenal crisis (AC) is the most severe manifestation of adrenal insufficiency, still responsible for a high mortality of affected patients, especially with primary adrenal insufficiency (PAI). Its presentation is insidious, leading to a delayed diagnosis and treatment. Patient education is crucial in the prevention and self-management of AC.

Aim of the study: We want to evaluate the incidence, features (symptoms, signs, laboratory findings), precipitating and predisposing factors of AC.

Methods: A total of 132 patients with PAI were enrolled. Patients’ characteristics and information on their previous AC were collected through a questionnaire and clinical documentation, supplied by patients or retrieved from archives of the Hospitals of Padova and Venice-Mestre.

Results: Among our patients, the most frequent cause of PAI was autoimmune adrenalitis (92.4%), mainly associated with other autoimmune comorbidities. The 65.9% of patients experienced at least one AC, with an incidence of 10.5/100 patient-years. In 55% of cases, AC occurred after the diagnosis of PAI. The most frequent symptoms and signs of AC were fatigue (96%), gastrointestinal disorders (39-85%), hypotension (57%), and hyperpigmentation (57%). Hyponatremia and hyperkalemia were found respectively in 77% and 32% of cases of AC. The most frequent trigger factors were vomiting and diarrhea (65%), infections (38%) and emotional stress (29%). Patients with a high number of autoimmune comorbidities and those with premature ovarian insufficiency (POI) had a significantly higher risk of AC (P <0.02).

Conclusions: AC is still a frequent complication of patients with PAI, especially when affected with other autoimmune comorbidities or with POI. AC awareness among clinicians, patients, and their care-givers is critical to prevent, recognise and adequately treat this life-threatening complication.