Predictors of increased vulnerability for adrenal crises in patients with chronic adrenal insufficiency - long-term follow-up of an initial prospective study

Irina Chifu; Anna Lynn Schreiber; Marcus Quinkler; Holger S Willenberg; Nicole Reisch; Felix Beuschlein; Stefanie Hahner

doi:10.1530/endoabs.110.P86

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Endocrine Abstracts (2025) 110 P86 | DOI: 10.1530/endoabs.110.P86

ECEESPE2025 Poster Presentations Adrenal and Cardiovascular Endocrinology (169 abstracts)

Predictors of increased vulnerability for adrenal crises in patients with chronic adrenal insufficiency – long-term follow-up of an initial prospective study

Irina Chifu ¹ , Anna Lynn Schreiber ¹ , Marcus Quinkler ² , Holger S Willenberg ³ , Nicole Reisch ⁴ , Felix Beuschlein ⁵ & Stefanie Hahner ¹

Author affiliations

¹University Hospital Wuerzburg, Endocrinology, Würzburg, Germany; ²Endokrinologiepraxis am Stuttgarter Platz, Endocrinology, Berlin, Germany; ³Rockstock University Medical Center, Endocrinology, Rostock, Germany; ⁴Klinikum der Universität München, Endocrinology, München, Germany; ⁵Universitätsspital Zürich, Endocrinology, Zürich, Switzerland

JOINT1444

Background: Despite increasing patient education, the prevalence and mortality of adrenal crises (AC) remain high in individuals with adrenal insufficiency (AI). Effective prevention is limited by the absence of established risk profiles. A previous 2-year prospective study identified a positive history of AC as the sole significant risk factor for future AC.

Objective: This study aims to reassess the frequency and predictors of AC over a long-term follow-up period (14 years) within the original study population.

Materials and methods: Patients from the initial prospective study (n=423) were re-contacted for a 14-year follow-up via questionnaire. AC prevalence was calculated per 100 patient-years (py). Parameters assessed included glucocorticoid (GC) and mineralocorticoid (MC) replacement therapy, dose regimen, possession of an emergency card and hydrocortisone injection, education status, regular GC dose adjustments, comorbidities, and co-medications.

Results: A total of 200 patients responded (70% female, 55% primary AI). AC prevalence increased from 8.8 AC/py to 11.6 AC/py. Seventeen (8.5%) patients died during the observation period. No significant differences were observed in disease duration, GC replacement dose, or changes in GC dose/preparation between patients who experienced AC and those who did not during the observation period. The highest risk for recurrent AC was observed in patients with a history of AC at baseline compared to those without prior AC (OR 7.1, 95% CI 2.3–21.6). Logistic regression identified AI etiology, prior AC history, type 2 diabetes mellitus, hypothyroidism, and frequency of regular GC dose adjustments as significant predictors of AC. Except for AI etiology, these factors remained significant predictors of AC in the subgroup of patients primary AI.

Conclusion: This study confirms previous findings that a history of AC is the strongest predictor of future AC and identifies additional risk factors contributing to individual vulnerability. These results support the development of personalized risk assessment and prevention strategies for AC.