Endocrine Abstracts

Background

Increased mortality risk of patients with adrenal insufficiency has been inconsistently reported. This might have resulted from the disparity of time and place of clinical care between the study patients and reference population. Also, data of patients with secondary adrenal insufficiency was limited as majority focused on other types of pituitary disorders. Therefore, we compared all-cause mortality of patients with primary and secondary adrenal insufficiency with individually matched controls.

Subjects

In a UK general practitioner database (Clinical Practice Research Datalink; CPRD), 6821 patients with adrenal insufficiency of any type (2052 primary adrenal insufficiency, 3948 secondary) were compared with 67564 matched controls (20366 primary, 39134 secondary).

Methods

Each study patient was individually matched with up to 10 controls who had the same sex, GP practice (representing place of clinical care and degree of deprivation), 5-year strata of the year of birth, and 5-year strata of the start of follow-up. Follow-up began on the latest of the date at which patients were diagnosed, registered to GP, or the GP provided standard information. Follow-up finished on the earliest date of death, or de-registering from the GP. All-cause mortality rate and the hazard ratio of the study patients relative to controls was analysed in overall and separately according to type of adrenal insufficiency.

Results

In adrenal insufficiency of any type, the mortality rate of the patients was significantly higher than controls (35.2 [95%CI, 33.4–37.0] vs. 21.0 [20.6–21.5] per 1000 person-years, P <0.0001) with a follow-up period of 40799 and 406899 person-years, respectively. The hazard ratio of mortality in adrenal insufficiency of any type was increased (1.68 [95%CI, 1.58–1.77], P <0.0001). In patients with primary adrenal insufficiency, the hazard ratio was 1.83 (95%CI, 1.66–2.02, P <0.0001), which was higher than those with secondary adrenal insufficiency (HR, 1.52 [95%CI, 1.40–1.64], P <0.0001).

Conclusion

With taking account of sex, age, time and place of clinical care, all-cause mortality risk remained increased in both primary and secondary adrenal insufficiency patients but more predominant in primary adrenal insufficiency.