ECE2019 Poster Presentations Adrenal and Neuroendocrine Tumours 2 (60 abstracts)
InfeCtious disease in patients with Adrenal endocRinOpathies: the ICARO prospective observational study
Marianna Minnetti 1 , Valeria Hasenmajer 1 , Emilia Sbardella 1 , Francesco Angelini 1 , Ilaria Bonaventura 1 , Chiara Simeoli 2 , Sabrina Chiloiro 3 , Carlotta Pozza 1 , Daniele Gianfrilli 1 , Laura De Marinis 3 , Rosario Pivonello 2 , Andrea Lenzi 1 & Andrea M Isidori 1
1Department of Experimental Medicine - ‘Sapienza’ University of Rome, Rome, Italy; 2Dipartimento di Medicina Clinica e Chirurgia, Università Federico II di Napoli, Naples, Italy; 3Department of Endocrinology, Catholic University of Rome, Rome, Italy.
Introduction: Cushing’s Syndrome (CS) is associated with an increased frequency and severity of infections. Mild hypercortisolism (MI) from adrenal incidentalomas has been associated with various complications, but data on infections are scarce. Retrospective data on patients with adrenal insufficiency (AI) showed an increased mortality attributed to infections. The approach used was very heterogeneous for all these studies. The aim of the study is to prospectively evaluate the rate, duration and severity of infectious disease in patients with various degrees of glucocorticoid excess and defect, through a unique validated self-reported questionnaire.
Methods: From January to December 2018, 634 participants completed a modified version of the German National Cohort Questionnaire, containing 46 items on the frequency of respiratory, gastrointestinal tract, bladder, kidney and skin infections over the past 12 months. Group of interest were subjects with CS, MI or AI on conventional replacement therapy. Control group consisted of patients not affect by overt endocrinopathies. Exclusion criteria were severe comorbidities, complications of endocrinopathies (i.e. uncontrolled diabetes) and malignancies. A cumulative odds ordinal logistic regression with proportional odds was run to determine the effect of adrenal disorders, age and gonadal status on infections.
Results: 347 participants met the inclusion criteria for the group of interest: 137 patients had adrenal endocrinopathies (31 CS, 85 AI and 21 MI), the remaining 210 were classified as controls. Compared to healthy subjects, the odds of increased number of Urinary Tract Infections (UTIs) in 12 months was 7.8 in CS (95%CI, 3.3 to 18.6; P<0.001), 2.9 in MH (1.0 to 8.3; P=0.046) and 2.4 in AI (1.2 to 4.8; P=0.017). Age (P=0.149) and gonadal status (P=0.551) did not modify the associations with increased UTIs. Furthermore, CS and MI patients took antibiotics to treat UTIs more often than controls (respectively P=0.006 and P=0.007). The odds of increased number of pneumonia was 2.8 in CS (1.1 to 6.8; P=0.024). AI patients felt more vulnerable about infections than controls (20% vs 9.8%; P=0.012) and they were more frequently admitted to hospital compared to controls (23.6% vs 12%; P=0.038).
Conclusions: Our findings indicate a higher prevalence of self-reported infections, especially of the urinary tracts, among patients with imbalances in glucocorticoid levels, not only in overt CS, but also in MI and AI. The results underline the need for further studies on the relationship between glucocorticoids and the immune system.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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