Endocrine Abstracts

Introduction: If untreated, adrenal insufficiency (AI) leads to premature death. Hospital record data suggest mortality associated with primary (PAI) and secondary AI (SAI) to be 2–3-fold higher than in the general population. Major causes of death include cardiovascular disease, Addisonian crises, brain tumours and infections; however, there is little further characterization of patients who died.

Design: We analysed real-world 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 who had died and those alive for each AI subset. Patients with congenital adrenal hyperplasia or tertiary AI were excluded. 1798 patients were included (626 PAI, 1172 SAI) in the current analysis.

Results: To November 2016, 21 deaths had occurred (7 PAI, 14 SAI). Causes of death were cardiovascular (n=8), infection (n=3), unclear (n=3), Addisonian crisis (n=1), suicide (n=2), renal failure, drug-induced hepatitis, cachexia and brain tumour (each n=1). Patients who died were significantly older at enrolment than those alive (PAI, 63.4±13.4 vs 50.0±15.8 years, P=0.0253; SAI, 64.0±16.6 vs 54.3±16.2 years, P=0.0250). Interestingly, duration of AI was shorter in patients with PAI who died versus alive patients (6.5±5.7 vs 16.3±13.1 years, P=0.0035), whereas the reverse was true for SAI (20.4±13.2 vs 13.7±11.1 years, P=0.0257). There were no significant differences in sex, BMI, blood pressure, triglycerides, LDL-cholesterol, cholesterol or HbA1c between the deceased and alive cohorts. Patients who died were generally more likely to have hypertension (PAI, 85.7% vs 21.8%, P=0.0007; SAI, 71.4% vs 33.9%, P=0.0076) and diabetes mellitus (PAI, 57.1% vs 14.4%, P=0.0112; SAI, 28.6% vs 11.5%, ns) at study inclusion.

Conclusions: This is the first study providing detailed characteristics of AI patients who died. Hypertension and diabetes, as well as infectious diseases, appear to play a major role in mortality.