Endocrine Abstracts

Introduction: Adrenal Insufficiency (AI) is a heterogeneous condition comprising primary, secondary and tertiary disease. Individuals with AI suffer more frequent infections and take longer to recover. Adrenal Crises (ACs), most commonly precipitated by infections, are an acute life-threatening complication with a reported mortality of 6%. ACs are, at least in part, potentially preventable and outcomes are improved by early initiation of high-dose glucocorticoids. Currently, there is a scarcity of information concerning the burden of AI episodes. We therefore utilised ‘Hospital Episode Statistics’ (HES) data to understand current practices and resources associated with AI patients.

Materials and Methods: The HES dataset contains details of all admissions and outpatient appointments at NHS hospitals in England after translating clinical information into a standardised set of codes. Spells between 1st April 2018 and 31st March 2023, focusing on HES codes E27.1 (Primary AI) [n=57,125], E27.2 (Adrenal Crisis) [n=12,640] and E27.4 (Other and unspecified AI) [n=79,965] were analysed for admissions, length of stay, costs, follow-up, and readmissions.

Results: The data reveal stable admissions for E27.2, reduced E27.1 admissions during COVID-19, and steadily increasing E27.4 admissions. The largest number of patients were coded as E27.4 rising consistently since 2018/2019. Length of stay was between 10 and 18 days and increased for E27.2 by 44% since 2018/19. Patients with primary pneumonia and concomitant AI had a longer mean duration of admission than those without AI; and were more likely to require critical care. Overall, <3% of patients were admitted to ICU. The mean cost per hospital stay increased over the analysis period, with the most marked increase being for E27.2 which rose 26% since 2019/20. Average costs in 2022/23 were £4,409 for E27.1; £6,579 for E27.2; and £4,726 for E27.4 Ten percent of patients had more than one non-elective readmission within 12 months of initial admission. Specialist Endocrinology follow-up following admission was low. Centres treating >400 episodes a year followed-up between 19% and 30% of patients with primary or secondary AI within 26 weeks. Only 33% of patients admitted with AC in 2022/23 were followed up.

Conclusion: The number of patients admitted to hospital with AI has increased since 2018/19. Costs and length of stay have risen significantly. Patients with AI and concomitant disease are more likely to have longer duration of admission and be re-admitted than those without AI. Follow-up of these patients by endocrinologists appears surprisingly low.