Endocrine Abstracts

Objective: Whether glucocorticoid (GC)-induced adrenal insufficiency may cause premature mortality in GC-users is not known. We conducted a retrospective cohort study to investigate if undiagnosed and undertreated GC-induced adrenal insufficiency is a contributor to premature death.

Methods: Information on dispensed prescriptions in West Sweden from 2007 to 2014 was obtained from the Swedish Prescribed Drug Register. Cause of death was collected from the Swedish Cause of Death Register. Of 223 211 patients who received oral GC prescriptions, 665 died from sepsis within 6 months from their last prescription. Three hundred of these, who had died in hospital, were randomly selected for further investigation. The medical records were initially reviewed by one investigator. Two additional investigators independently reviewed the medical records of those whose deaths were suspected to be caused by GC-induced adrenal insufficiency.

Results: Of 300 patients (121 females, 40%), 212 (75%) were prescribed GC treatment at admission. The mean age was 76±11 years (range 30–99). Undiagnosed or undertreated GC-induced adrenal insufficiency was considered a probable contributor to death by at least two investigators in 11 (3.7%) patients. In 5 of these 11 cases, long-term GC therapy was abruptly discontinued during the hospitalization. Undiagnosed or undertreated GC-induced adrenal insufficiency was considered a possible contributing factor to death in a further 36 (12%) patients.

Conclusion: GC-induced adrenal insufficiency is an important contributor to premature death in GC users. Increased awareness of adrenal insufficiency during intercurrent illness and following cessation of GC treatment is essential.