Addison’s Disease Symptoms – A Cross Sectional Study in Urban South Africa

Abstract

BackgroundAddison’s disease is a potentially life-threatening disorder, and prompt diagnosis, and introduction of steroid replacement has resulted in near normal life-expectancy. There are limited data describing the clinical presentation of Addison’s disease in South Africa. It is hypothesised that patients may present in advanced state of ill-health, compared to Western countries.PatientsA national database of patients was compiled from primary care, referral centres and private practices. 148 patients were enrolled (97 white, 34 mixed ancestry, 5 Asian and 12 black).MethodsDemographic and clinical data were elicited using questionnaires. Biochemical data were obtained from folder reviews and laboratory archived results.ResultsThe majority of the cohort was women (62%). The median and inter-quartile age range (IQR) of patients at enrolment was 46.0 (32.0–61.0) years, with a wide range from 2.8–88.0 years. The median and IQR age at initial diagnosis was 34.0 (20.0–45.0) years (range 0.02–77.0) years, indicating that at the time of enrolment, the patients, on average, were diagnosed with Addison’s disease 12 years previously. Hyperpigmentation was observed in 76%, nausea and vomiting occurred in more than 40%, and weight loss was noted in 25%. Loss of consciousness as a presenting feature was recorded in 20%. with a 95% confidence interval [CI] of (14–28%) and shock occurred in 5% CI (1.5–8.5%). Case-finding was recorded at 3.1 per million.ConclusionsThe usual constellation of hyperpigmentation, nausea, vomiting and weight loss suggests Addison’s disease, but a significant proportion present with an advanced state of ill-health and Addisonian crises. A lower prevalence rate, compared to Western countries is suggested.

Poor quality of life, depressed mood, and memory impairment may be mediated by sleep disruption in patients with Addison's disease

“…It is possible to run latent variable models with 100 participants [22]. Obtaining larger samples can be challenging when studying rare diseases such as AD (a global population prevalence of 39–117 per million [23], and a prevalence in South Africa of 3.1 per million [24]). We believe that, given our study population, there were a sufficient number of participants in our final sample ( N = 120).…”

MANAGEMENT OF ENDOCRINE DISEASE: Epidemiology, quality of life and complications of primary adrenal insufficiency: a review

“…1). However, lower prevalence rates have been reported outside Europe (11,12,13). The incidence has been estimated at 4-6 cases per million per year and is probably on a rising course (5,7,8,10,14,15,16).…”

Male and Female Hypogonadism are Highly Prevalent in South Africans with Addison’s Disease

“…Approval for the study was obtained from the University of Cape Town Human Research and Ethics Committee. The subjects were enrolled from the South African AD cohort, a nationwide registry of all patients with AD, whose underlying aetiology [ 15 ] and clinical picture at presentation have been published previously [ 16 ] . Subjects older than 18 years were eligible to participate.…”