Endocrine Abstracts

Introduction: Adrenal crises (ACs) are life-threatening events in patients with primary (PAI) or secondary (SAI) adrenal insufficiency, occurring ~4–10 times per 100 patient-years. Major causes of ACs are infections, especially gastroenteritis and tonsillitis/laryngitis. Risk factors for ACs remain ill defined, but could include concomitant endocrine diseases (diabetes mellitus, premature ovarian failure) in PAI, diabetes insipidus in SAI, and concomitant non-endocrine diseases (obesity, asthma, cancer, and cardiac and neurological diseases) in both groups.

Design: We analysed data from the European Adrenal Insufficiency Registry (EU-AIR; NCT01661387) with centres across Germany, the Netherlands, Sweden and the UK. Clinical and biochemical data at enrolment were compared for patients with frequent (n≥2) and infrequent ACs (n<2) in each AI subset; 1969 patients were included (727 PAI, 1172 SAI) in the current analysis. Patients with congenital adrenal hyperplasia or tertiary AI were excluded.

Results: To November 2016, 27 patients with frequent ACs were identified (19 PAI, 8 SAI). The number of adverse events/patient was significantly higher in the frequent than the infrequent AC group in both subsets (PAI, 15.3±14.0 vs 3.9±6.5; SAI, 19.6±18.5 vs 2.2±4.3, respectively; P=0.0024). Patients with frequent ACs were more likely to be female (PAI, 78.9% vs 65.1%; SAI, 75.0% vs 47.9%), and less likely to have hypertension (PAI, 5.3% vs 21.0%; SAI, 25.0% vs 34.4%), with a lower BMI (PAI, 24.2±4.7 vs 26.2±4.9 kg/m²; SAI, 26.0±5.7 vs 28.7±5.1 kg/m²). There were no differences in daily glucocorticoid dose, frequency of diabetes mellitus, HbA1c levels, lipid profiles or use of statins. Interestingly, disease duration was shorter in patients with frequent compared with infrequent ACs in PAI (12.8±13.2 vs 18.9±14.5 years), whereas the opposite was true in SAI (15.6±12.3 vs 13.8±11.2 years).

Conclusions: Data suggest that known cardiovascular risk factors appear not to feature in the AC risk profile.