Endocrine Abstracts

Introduction: Adrenal crisis is a potentially life-threatening complication in primary adrenal failure. Our objective was to investigate the frequency of adrenal crises in patients with autoimmune Addison’s disease (AD) in the Techniker Krankenkasse (TK), one of the largest German Health Insurance providers, that covers more than 10% of the German population.

Design: The Statutory Health Insurance (SHI) database of the TK was analysed for diagnostic codes and prescription patterns over an observation period from 01.01.2008 to 31.12.2012. After exclusion of secondary, iatrogenic or other non-idiopathic forms of adrenal insufficiency, n=1364 diagnoses of autoimmune mediated AD were recorded in the SHI database. A query for ICD-code E27.2 (adrenal crisis) was performed in this subgroup for the years 2008–2012.

Results: Adrenal crises in patients with autoimmune AD were documented with a frequency up to 14–17/100 patient years. While AD is more frequent in females (OR 1.6), adrenal crises occur more often in male patients (11 vs 9%). We could not find any significant seasonal or regional effects. The need for hospital admission was higher in females (10 vs 7%) and lower in patients 30–50 years of age compared to younger and older ones.

Conclusions: In this study, we indentified an unexpected and so far unknown high risk for adrenal crises in patients with autoimmune AD. Since former investigations in patients with primary and secondary adrenal insufficiency showed a distinctly lower frequency, the risk seems to be higher for patients with autoimmune induced primary adrenal insuffiency. These findings illustrate the necessity to identify the true incidence of adrenal crises and its triggering factors. If confirmed they warrant intensified efforts for the prevention of adrenal crises.