Endocrine Abstracts

Adrenal crisis (AC) is a life threatening condition in chronic adrenal insufficiency (AI). Furthermore, recent data demonstrate increased mortality in this patient group.

Incidence and causes of adrenal crisis as well as general morbidity and hospitalization was assessed in 472 patients in a prospective trial. Patients were contacted via mail every 6 months and in case of AC additionally by phone to evaluate the exact circumstances of AC. Criteria for AC were predefined as no commonly accepted definition exists and grading of severity was additionally performed.

Nine hundred and twenty-three patients were contacted, 472 patients (52% primary AI, 48% secondary AI) sent questionnaires and 381 patients completed the full 2 year study period, covering 815 patient years. Five hundred and thirty cases of acute clinical impairment were reported, 62 fulfilled our predefined criteria of AC, resulting in a frequency of 7.6 per 100 patient/years, which is high compared to results from previous retrospective analyses. 65.5% were treated as inpatients (grade II), with 9.5% receiving intensive care (grade III). Two patients died during the study period in the context of AC. Main precipitating factor was infectious disease (39% of cases), but also psychic distress, neglected hydrocortisone intake, strong pain, heat and other factors were reported. Ninety-five percent of patients possessed an emergency card but only 28% were equipped with an emergency set. Patients at work demonstrated a mean absence from work of 16 days per year. 12.7% of participants reported additional hospitalization for other reasons than AI.

In this prospective study, we demonstrate that despite patient education and established glucocorticoid replacement patients are at a substantial risk to experience AC which has been fatal in 3%. This demonstrates that there is still a need of improved strategies for prevention of AC, e.g. frequently repeated patient education and broader distribution of emergency sets.