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Published in: BMC Endocrine Disorders 1/2014

Open Access 01-12-2014 | Research article

A descriptive study of adrenal crises in adults with adrenal insufficiency: increased risk with age and in those with bacterial infections

Authors: R Louise Rushworth, David J Torpy

Published in: BMC Endocrine Disorders | Issue 1/2014

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Abstract

Background

An adrenal crisis (AC) is a major cause of morbidity in hypoadrenal patients. However, there is little information available on the incidence and underlying causes of AC.

Methods

The aim of the present study was to describe the incidence of AC in New South Wales (NSW), Australia. Using a health department database, we selected de-identified data on all adults aged 20 years and over who were treated in any hospital in NSW between July1, 2000-June 30, 2011, with either a principal or secondary diagnosis of an AC. AC admission rates were calculated overall and within age categories. Frequencies of co-morbid diagnoses were analysed by age and sex groups. Poisson regression was used to assess the significance of the observed change in AC related admissions with age, while controlling for any secular trends by including year in the model. Chi sq tests were used to assess the differences in frequencies of categorical variables between groups.

Results

824 patients received treatment for an AC in hospital, corresponding to 74.9 admissions/year. The majority (62.5%) of the patients were women and 52.8% were aged 60 years and over. Admission rates were significantly associated with increasing age (p < 0.0001). Patients in the 60–69, 70–79 and 80+ age groups had the highest average admission rates (24.3, 35.2 and 45.8 per million/year). A principal or secondary diagnosis of an infection was reported in 317 (38.5%) patients and infection was significantly associated with age (p < 0.0001) with older patients having the highest proportion of cases. The most frequent infections were pneumonia/lower respiratory tract infection in 85 (10.3%) cases and urinary tract infection (UTI) in 82 (10.0%) patients. Women experienced 78.0% of the reported UTIs. There were 125 patients (15.2%) with an AC and a record of gastroenteritis. Twenty-six (3.2%) patients died in hospital but, of these, only 4 deaths (0.9%) were recorded among the 467 patients with a principal diagnosis of an AC.

Conclusions

The incidence of AC increases with age. Infections, especially bacterial infections, are associated with the incidence of ACs and this increases with age.
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Literature
1.
go back to reference Bergthorsdottir R, Leonsson-Zachrisson M, Odén A, Johannsson G: Premature mortality in patients with Addison's disease: a population-based study. J Clin Endocrinol Metab. 2006, 91 (12): 4849-4853. 10.1210/jc.2006-0076.CrossRefPubMed Bergthorsdottir R, Leonsson-Zachrisson M, Odén A, Johannsson G: Premature mortality in patients with Addison's disease: a population-based study. J Clin Endocrinol Metab. 2006, 91 (12): 4849-4853. 10.1210/jc.2006-0076.CrossRefPubMed
2.
go back to reference Erichsen MM, Løvås K, Fougner KJ, Svartberg J, Hauge ER, Bollerslev J, Berg JP, Mella B, Husebye ES: Normal overall mortality rate in Addison's disease, but young patients are at risk of premature death. Eur J Endocrinol. 2009, 160 (2): 233-237.CrossRefPubMed Erichsen MM, Løvås K, Fougner KJ, Svartberg J, Hauge ER, Bollerslev J, Berg JP, Mella B, Husebye ES: Normal overall mortality rate in Addison's disease, but young patients are at risk of premature death. Eur J Endocrinol. 2009, 160 (2): 233-237.CrossRefPubMed
3.
go back to reference Arlt W, Allolio B: Adrenal insufficiency. Lancet. 2003, 361 (9372): 1881-1893. 10.1016/S0140-6736(03)13492-7.CrossRefPubMed Arlt W, Allolio B: Adrenal insufficiency. Lancet. 2003, 361 (9372): 1881-1893. 10.1016/S0140-6736(03)13492-7.CrossRefPubMed
4.
go back to reference Regal M, Páramo C, Sierra SM, Garcia-Mayor RV: Prevalence and incidence of hypopituitarism in an adult Caucasian population in northwestern Spain. Clin Endocrinol. 2001, 55 (6): 735-740. 10.1046/j.1365-2265.2001.01406.x.CrossRef Regal M, Páramo C, Sierra SM, Garcia-Mayor RV: Prevalence and incidence of hypopituitarism in an adult Caucasian population in northwestern Spain. Clin Endocrinol. 2001, 55 (6): 735-740. 10.1046/j.1365-2265.2001.01406.x.CrossRef
5.
go back to reference Fernandez-Rodriguez E, Lopez-Raton M, Andujar P, Martinez-Silva IM, Cadarso-Suarez C, Casanueva FF, Bernabeu I: Epidemiology, mortality rate and survival in a homogeneous population of hypopituitary patients. Clin Endocrinol. 2013, 78 (2): 278-284. 10.1111/j.1365-2265.2012.04516.x.CrossRef Fernandez-Rodriguez E, Lopez-Raton M, Andujar P, Martinez-Silva IM, Cadarso-Suarez C, Casanueva FF, Bernabeu I: Epidemiology, mortality rate and survival in a homogeneous population of hypopituitary patients. Clin Endocrinol. 2013, 78 (2): 278-284. 10.1111/j.1365-2265.2012.04516.x.CrossRef
6.
go back to reference Hahner S, Allolio B: Therapeutic management of adrenal insufficiency. Best Pract Res Clin Endocrinol Metab. 2009, 23 (2): 167-179. 10.1016/j.beem.2008.09.009.CrossRefPubMed Hahner S, Allolio B: Therapeutic management of adrenal insufficiency. Best Pract Res Clin Endocrinol Metab. 2009, 23 (2): 167-179. 10.1016/j.beem.2008.09.009.CrossRefPubMed
7.
go back to reference Mah PM, Jenkins RC, Rostami-Hodjiegan A, Newell-Price J, Doane A, Ibbotson V, Tucker GT, Ross RJ: Weight-related dosing, timing and monitoring hydrocortisone replacement therapy in patients with adrenal insufficiency. Clin Endocrinol. 2004, 61 (3): 367-375. 10.1111/j.1365-2265.2004.02106.x.CrossRef Mah PM, Jenkins RC, Rostami-Hodjiegan A, Newell-Price J, Doane A, Ibbotson V, Tucker GT, Ross RJ: Weight-related dosing, timing and monitoring hydrocortisone replacement therapy in patients with adrenal insufficiency. Clin Endocrinol. 2004, 61 (3): 367-375. 10.1111/j.1365-2265.2004.02106.x.CrossRef
8.
go back to reference Quinkler M, Hahner S: What is the best long-term management strategy for patients with primary adrenal insufficiency?. Clin Endocrinol (Oxf). 2012, 76 (1): 21-25. 10.1111/j.1365-2265.2011.04103.x.CrossRef Quinkler M, Hahner S: What is the best long-term management strategy for patients with primary adrenal insufficiency?. Clin Endocrinol (Oxf). 2012, 76 (1): 21-25. 10.1111/j.1365-2265.2011.04103.x.CrossRef
9.
go back to reference White K, Arlt W: Adrenal crisis in treated Addison's disease: a predictable but under-managed event. Eur J Endocrinol. 2010, 162 (1): 115-120. 10.1530/EJE-09-0559.CrossRefPubMed White K, Arlt W: Adrenal crisis in treated Addison's disease: a predictable but under-managed event. Eur J Endocrinol. 2010, 162 (1): 115-120. 10.1530/EJE-09-0559.CrossRefPubMed
10.
go back to reference Flemming TG, Kristensen LO: Quality of self-care in patients on replacement therapy with hydrocortisone. J Intern Med. 1999, 246 (5): 497-501. 10.1046/j.1365-2796.1999.00538.x.CrossRefPubMed Flemming TG, Kristensen LO: Quality of self-care in patients on replacement therapy with hydrocortisone. J Intern Med. 1999, 246 (5): 497-501. 10.1046/j.1365-2796.1999.00538.x.CrossRefPubMed
11.
go back to reference Quinkler M, Hahner S, Johannsson G, Stewart PM: Saving lives of patients with adrenal insufficiency: a pan-European initiative?. Clin Endocrinol. 2014, 80 (3): 319-321. 10.1111/cen.12378.CrossRef Quinkler M, Hahner S, Johannsson G, Stewart PM: Saving lives of patients with adrenal insufficiency: a pan-European initiative?. Clin Endocrinol. 2014, 80 (3): 319-321. 10.1111/cen.12378.CrossRef
12.
go back to reference Husebye ES, Allolio B, Arlt W, Badenhoop K, Bensing S, Betterle C, Falorni A, Gan EH, Hulting AL, Kasperlik-Zaluska A, Kämpe O, Løvås K, Meyer G, Pearce SH: Consensus statement on the diagnosis, treatment and follow-up of patients with primary adrenal insufficiency. J Intern Med. 2014, 275 (2): 104-115. 10.1111/joim.12162.CrossRefPubMed Husebye ES, Allolio B, Arlt W, Badenhoop K, Bensing S, Betterle C, Falorni A, Gan EH, Hulting AL, Kasperlik-Zaluska A, Kämpe O, Løvås K, Meyer G, Pearce SH: Consensus statement on the diagnosis, treatment and follow-up of patients with primary adrenal insufficiency. J Intern Med. 2014, 275 (2): 104-115. 10.1111/joim.12162.CrossRefPubMed
14.
go back to reference World Health Organisation: International Statistical Classification of Diseases and Health Related Problems, 10th Revision (ICD 10). 2011, Geneva: WHO World Health Organisation: International Statistical Classification of Diseases and Health Related Problems, 10th Revision (ICD 10). 2011, Geneva: WHO
15.
go back to reference Hahner S, Loeffler M, Bleicken B, Drechsler C, Milovanovic D, Fassnacht M, Ventz M, Quinkler M, Allolio B: Epidemiology of adrenal crisis in chronic adrenal insufficiency: the need for new prevention strategies. Eur J Endocrinol. 2010, 162 (3): 597-602. 10.1530/EJE-09-0884.CrossRefPubMed Hahner S, Loeffler M, Bleicken B, Drechsler C, Milovanovic D, Fassnacht M, Ventz M, Quinkler M, Allolio B: Epidemiology of adrenal crisis in chronic adrenal insufficiency: the need for new prevention strategies. Eur J Endocrinol. 2010, 162 (3): 597-602. 10.1530/EJE-09-0884.CrossRefPubMed
16.
go back to reference Nieman L: Treatment of adrenal insufficiency in adults. UpToDate. Edited by: Lacroix A. 2013, Waltham, MA: Wolters Kluwer Nieman L: Treatment of adrenal insufficiency in adults. UpToDate. Edited by: Lacroix A. 2013, Waltham, MA: Wolters Kluwer
17.
go back to reference Smans LC, Souverein PC, Leufkens HG, Hoepelman AI, Zelissen PM: Increased use of antimicrobial agents and hospital admission for infections in patients with primary adrenal insufficiency: a cohort study. Eur J Endocrinol. 2013, 168 (4): 609-614. 10.1530/EJE-12-0879.CrossRefPubMed Smans LC, Souverein PC, Leufkens HG, Hoepelman AI, Zelissen PM: Increased use of antimicrobial agents and hospital admission for infections in patients with primary adrenal insufficiency: a cohort study. Eur J Endocrinol. 2013, 168 (4): 609-614. 10.1530/EJE-12-0879.CrossRefPubMed
18.
go back to reference Chen YC, Chen YC, Chou LF, Chen TJ, Hwang SJ: Adrenal insufficiency in the elderly: a nationwide study of hospitalizations in Taiwan. Tohoku J Exp Med. 2010, 221 (4): 281-285. 10.1620/tjem.221.281.CrossRefPubMed Chen YC, Chen YC, Chou LF, Chen TJ, Hwang SJ: Adrenal insufficiency in the elderly: a nationwide study of hospitalizations in Taiwan. Tohoku J Exp Med. 2010, 221 (4): 281-285. 10.1620/tjem.221.281.CrossRefPubMed
19.
go back to reference Wotton CJ, Goldacre MJ: Risk of invasive pneumococcal disease in people admitted to hospital with selected immune-mediated diseases: record linkage cohort analyses. J Epidemiol Community Health. 2012, 66 (12): 1177-1181. 10.1136/jech-2011-200168.CrossRefPubMed Wotton CJ, Goldacre MJ: Risk of invasive pneumococcal disease in people admitted to hospital with selected immune-mediated diseases: record linkage cohort analyses. J Epidemiol Community Health. 2012, 66 (12): 1177-1181. 10.1136/jech-2011-200168.CrossRefPubMed
20.
go back to reference Marik PE, Pastores SM, Annane D, Meduri GU, Sprung CL, Arlt W, Keh D, Briegel J, Beishuizen A, Dimopoulou I, Tsagarakis S, Singer M, Chrousos GP, Zaloga G, Bokhari F, Vogeser M: Recommendations for the diagnosis and management of corticosteroid insufficiency in critically ill adult patients: consensus statements from an international task force by the American College of Critical Care Medicine. Crit Care Med. 2008, 36: 1937-1949. 10.1097/CCM.0b013e31817603ba.CrossRefPubMed Marik PE, Pastores SM, Annane D, Meduri GU, Sprung CL, Arlt W, Keh D, Briegel J, Beishuizen A, Dimopoulou I, Tsagarakis S, Singer M, Chrousos GP, Zaloga G, Bokhari F, Vogeser M: Recommendations for the diagnosis and management of corticosteroid insufficiency in critically ill adult patients: consensus statements from an international task force by the American College of Critical Care Medicine. Crit Care Med. 2008, 36: 1937-1949. 10.1097/CCM.0b013e31817603ba.CrossRefPubMed
21.
go back to reference Leelarathna L, Breen L, Powrie JK, Thomas SM, Guzder R, McGowan B, Carroll PV: Co-morbidities, management and clinical outcome of auto-immune Addison's disease. Endocrine. 2010, 38 (1): 113-117. 10.1007/s12020-010-9359-8.CrossRefPubMed Leelarathna L, Breen L, Powrie JK, Thomas SM, Guzder R, McGowan B, Carroll PV: Co-morbidities, management and clinical outcome of auto-immune Addison's disease. Endocrine. 2010, 38 (1): 113-117. 10.1007/s12020-010-9359-8.CrossRefPubMed
22.
go back to reference Björnsdottir S, Sääf M, Bensing S, Kämpe O, Michaëlsson K, Ludvigsson JF: Risk of hip fracture in Addison's disease: a population-based cohort study. J Intern Med. 2011, 270 (2): 187-195. 10.1111/j.1365-2796.2011.02352.x.CrossRefPubMed Björnsdottir S, Sääf M, Bensing S, Kämpe O, Michaëlsson K, Ludvigsson JF: Risk of hip fracture in Addison's disease: a population-based cohort study. J Intern Med. 2011, 270 (2): 187-195. 10.1111/j.1365-2796.2011.02352.x.CrossRefPubMed
23.
go back to reference Rodhe N, Löfgren S, Matussek A, André M, Englund L, Kühn I, Mölstad S: Asymptomatic bacteriuria in the elderly: high prevalence and high turnover of strains. Scand J Infect Dis. 2008, 40 (10): 804-810. 10.1080/00365540802195242.CrossRefPubMed Rodhe N, Löfgren S, Matussek A, André M, Englund L, Kühn I, Mölstad S: Asymptomatic bacteriuria in the elderly: high prevalence and high turnover of strains. Scand J Infect Dis. 2008, 40 (10): 804-810. 10.1080/00365540802195242.CrossRefPubMed
24.
go back to reference Wynne HA, Blagburn J: Drug treatment in an ageing population: practical implications. Maturitas. 2010, 66: 246-250. 10.1016/j.maturitas.2010.03.004.CrossRefPubMed Wynne HA, Blagburn J: Drug treatment in an ageing population: practical implications. Maturitas. 2010, 66: 246-250. 10.1016/j.maturitas.2010.03.004.CrossRefPubMed
Metadata
Title
A descriptive study of adrenal crises in adults with adrenal insufficiency: increased risk with age and in those with bacterial infections
Authors
R Louise Rushworth
David J Torpy
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Endocrine Disorders / Issue 1/2014
Electronic ISSN: 1472-6823
DOI
https://doi.org/10.1186/1472-6823-14-79

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