The incidence of adrenal crisis in addison

Stokland Ann-Elin Meling; Agnes Judit Horvath; Aleksandra Debowska; Anders Jorgensen; Bjorn Gunnar Nedrebo; Bjorn Olav AEsvold; Daniel Hannisdal; Elin Korsgaard; Grethe Ueland; Hallvard Singsas; Ingrid Nermoen; Ingvild Dalen; Kari Lima; Lars Breivik; Margrethe Svendsen; Marianne Stedje; Steigen Maria Eriksson; Marianne Oksnes; Petya Milova; Steintorsdottir Sandra Dis; Sigrid Blika; Simon Kildal; Siri Carlsen; Stina Therese Sollid; Trine Finnes; Saevik AEse Bjorvatn; Eystein Sverre Husebye

doi:10.1530/endoabs.110.OC13.5

OC13.5

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Endocrine Abstracts (2025) 110 OC13.5 | DOI: 10.1530/endoabs.110.OC13.5

ECEESPE2025 Oral Communications Oral Communications 13: Adrenal and Cardiovascular Endocrinology Part 2 (6 abstracts)

The incidence of adrenal crisis in addison’s disease is low a survey of the national norwegian registry

Ann-Elin Meling Stokland ¹ , Agnes Judit Horvath ² , Aleksandra Debowska ³ , Anders Jørgensen ⁴ , Bjørn Gunnar Nedrebø ⁵ , Bjørn Olav Æsvold ⁶ , Daniel Hannisdal ⁷ , Elin Korsgaard ⁸ , Grethe Ueland ⁹ , Hallvard Singsås ⁶ , Ingrid Nermoen ¹⁰ , Ingvild Dalen ¹ , Kari Lima ¹⁰ , Lars Breivik ¹¹ , Margrethe Svendsen ¹² , Marianne Stedje ¹ , Maria Eriksson Steigen ⁶ , Marianne Oksnes ⁹ , Petya Milova ¹³ , Sandra Dis Steintorsdottir ⁴ , Sigrid Blika ¹³ , Simon Kildal ¹⁴ , Siri Carlsen ¹ , Stina Therese Sollid ¹⁵ , Trine Finnes ² , Æse Bjorvatn Sævik ¹⁶ & Eystein Sverre Husebye ^9,11

Author affiliations

¹Stavanger University Hospital, Stavanger, Norway; ²Innlandet Hospital Trust, Hamar, Norway; ³Vestfold Hospital, Tønsberg, Norway; ⁴Oslo University Hospital, Oslo, Norway; ⁵Haugesund Hospital, Haugesund, Norway; ⁶St. Olavs Hospital, Trondheim, Norway; ⁷Bærum Hospital, Bærum, Norway; ⁸Vestre Viken Hospital Trust, Kongsberg, Norway; ⁹Haukeland University Hospital, Bergen, Norway; ¹⁰Akershus University Hospital, Nordbyhagen, Norway; ¹¹University of Bergen, Bergen, Norway; ¹²Østfold Hospital, Fredrikstad, Norway; ¹³Telemark Hospital, Notodden, Norway; ¹⁴University Hospital of North Norway, Tromsø, Norway; ¹⁵Drammen Hospital, Drammen, Norway; ¹⁶Sørlandet Hospital Trust, Arendal, Norway

JOINT1853

Background: Adrenal crisis is a life-threatening emergency in patients with adrenal insufficiency. Despite preventive measures, previous studies indicate a rising incidence, yet detailed and validated investigations are lacking.

Methods: We included 743 patients with autoimmune primary adrenal insufficiency (Addison’s disease) identified through the Norwegian National Addison Registry. All medical records were reviewed for admissions between January 1, 2000, and December 31, 2023. Overt adrenal crisis was defined as an acute deterioration of health status associated with hypotension (systolic blood pressure<100 mmHg), hyponatremia (<130 mmol/l), hyperkalemia (>5 mmol/l) or hypoglycemia (<3.5 mmol/l). Incipient adrenal crisis was defined as marked and typical symptoms in the absence of objective features.

Results: After a median follow-up of 15 years, 64% of the patients had one or more crisis-related admissions. The incidence of overt adrenal crisis was 4.4 per 100 person years, while the incidence of incipient adrenal crisis was 7.0 per 100 person years. Over time, admission rates with incipient crisis increased, while admission rates with overt adrenal crisis remained stable. At admission, s-sodium<130 mmol/l and s-potassium>5 mmol/l was found in 17% and 13% of the cases, respectively. Four percent had serum glucose below 3.5 mmol/l and 1.8% below 2 mmol/l. Infection was the most common precipitating cause (52%). In 29% of cases, patients had administered oral stress dosing before admission, and 24% had injected hydrocortisone. These treatments were associated with a reduced odds of having crisis on arrival to hospital (oral, OR 0.44; 95% CI, 0,33-0,58, P=<0.001 and injection OR 0.64; 95% CI, 0.49-0.85, P=0.002). Crisis-related admissions were highest among the youngest patients and those with type 1 diabetes. Out of 1254 admissions, 13 patients (1%) died during the hospital stay. Adrenal crisis was deemed as a contributing case of death in four cases (0.3%).

Conclusions: The incidence of overt adrenal crisis is low, and in-hospital crisis-related mortality nearly absent. Wider use of oral stress dosing and pre-emergency hydrocortisone injections is needed to further reduce the risk of overt adrenal crises.