Premature Mortality in Patients with Addison’s Disease: A Population-Based Study

Bergthorsdottir, Ragnhildur; Leonsson-Zachrisson, Maria; Odén, Anders; Johannsson, Gudmundur

doi:10.1210/jc.2006-0076

Cited by 444 publications

(403 citation statements)

References 26 publications

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“…Afterwards, it has become increasingly clear that, on the contrary, despite glucocorticoid replacement therapy, mortality rate and morbidity remain increased in patients with adrenal insufficiency as compared to the general population [7][8][9][10].…”

Section: Discussionmentioning

confidence: 99%

“…In particular, there is a more than a two-fold increase in relative risk of death in Swedish patients with AD, predominantly due to cardiovascular, malignant, and infectious diseases [7,8]. The same for Norwegian patients with AD, particularly males, presenting with an increased risk of premature death due to infections, sudden death and acute adrenal failure [9].…”

Section: Discussionmentioning

confidence: 99%

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Improvement of anthropometric and metabolic parameters, and quality of life following treatment with dual-release hydrocortisone in patients with Addison’s disease

et al. 2015

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Disclosure statement: The Authors have nothing to disclose. 2Abstract Purpose: In patients with Addison's disease (AD), a dual-release preparation of hydrocortisone (Plenadren, PLEN) has been demonstrated to maintain cortisol levels in a more physiological range than conventional glucocorticoid therapy, and to exert positive effects. This study aimed to assess variations of anthropometric, metabolic and hormonal parameters in patients with AD after switching from conventional hydrocortisone (HC) treatment to PLEN.Methods: in nineteen AD patients (15 F and 4 M, age 27-65 yr) treated with HC 20 mg/day thrice daily, body weight, BMI, waist circumference, fasting glucose, HbA1c, serum lipids, plasma renin activity (PRA), electrolytes and blood pressure were evaluated at baseline, and 1, 3, 6 and 12 months after switching from HC to PLEN. At baseline, and after 1 and 12 months of PLEN, blood ACTH and cortisol (at 0800 h at fasting, and 30, 60, 90, 120 and 240 minutes after drug ingestion), and health-related quality of life (HRQoL), using 30-AddiQoL questionnaire, were evaluated.Results: During PLEN, waist and serum lipid progressively decreased. After 12 months of PLEN, a significant difference was observed in waist circumference (P=0.007), HbA1c (P=0.002), total and LDL-cholesterol levels (P<0.05). ACTH levels at 240 minutes and the area under the curve (AUC) were lower (P<0.05) during PLEN than HC, while cortisol peaks and AUC were similar. 30-AddiQoL total score also improved (P=0.04) during PLEN.Conclusions: In Addison's disease patients, PLEN reduces central adiposity, and improves glucose and metabolism parameters and HRQoL.3

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Improvement of anthropometric and metabolic parameters, and quality of life following treatment with dual-release hydrocortisone in patients with Addison’s disease

et al. 2015

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“…Initial studies in patients with both secondary 8,9 and primary adrenal insufficiency 10,11 used data registries and showed that they were at increased mortality risk, with some suggesting that endocrine and infectious causes contributed to this. 10,11 Subsequently, in a Swedish study 12 of patients with hypopituitarism, all 15 cases of death from infections occurred in patients with hypocortisolism.…”

Section: Definition and Epidemiologymentioning

confidence: 99%

“…10,11 Subsequently, in a Swedish study 12 of patients with hypopituitarism, all 15 cases of death from infections occurred in patients with hypocortisolism. Eight of these patients had a documented adrenal crisis, and 7 of these 8 died at home or upon arrival to the hospital.…”

Section: Definition and Epidemiologymentioning

confidence: 99%

Adrenal Crisis: Still a Deadly Event in the 21st Century

Puar

Stikkelbroeck

Smans

et al. 2016

The American Journal of Medicine

141

140

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Adrenal crisis is a life-threatening medical emergency, associated with a high mortality unless it is appropriately recognized and early treatment is rendered. Despite it being a treatable condition for almost 70 years, failure of adequate preventive measures or delayed treatment has often led to unnecessary deaths. Gastrointestinal illness is the most common precipitant for an adrenal crisis. Although most patients are educated about "sick day rules," patients, and physicians too, are often reluctant to increase their glucocorticoid doses or switch to parenteral injections, and thereby fail to avert the rapid deterioration of the patients' condition. Therefore, more can be done to prevent an adrenal crisis, as well as to ensure that adequate acute medical care is instituted after a crisis has occurred. There is generally a paucity of studies on adrenal crisis. Hence, we will review the current literature, while also focusing on the incidence, presentation, treatment, prevention strategies, and latest recommendations in terms of steroid dosing in stress situations.

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“…Recently, it has been demonstrated that the patients with PAI and SAI show a significantly reduced subjective health status (SHS), irrespective of age, sex, concomitant disease, and primary or secondary origin of AI (3,4). Importantly, also increased mortality has been described (5,6). These observations have renewed the discussion of optimal replacement treatment in AI after about 50 years of almost unchanged regimens.…”

Section: Introductionmentioning

confidence: 99%

Impaired subjective health status in chronic adrenal insufficiency: impact of different glucocorticoid replacement regimens

Bleicken

Hahner

Loeffler

et al. 2008

European Journal of Endocrinology

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Context: Recent studies have suggested that current glucocorticoid replacement therapies fail to fully restore well-being in patients with adrenal insufficiency (AI). Objective: To investigate the effect of different glucocorticoid preparations used for replacement therapy on subjective health status (SHS) in AI. Design and patients: In a cross-sectional study, primary and secondary AI patients were contacted by mail. Individual glucocorticoid replacement regimens, underlying diagnoses and comorbidities were verified by questionnaires and review of medical records. Patients were asked to complete three validated self-assessment questionnaires (Short Form 36 (SF-36), Giessen Complaint List (GBB-24), and Hospital Anxiety and Depression Scale). Results were compared with sex-and age-matched controls drawn from the questionnaire-specific reference cohort. Results: Of the 883 patients identified, 526 agreed to participate in the study. Completed questionnaire sets were available from 427 patients (primary AI nZ232; secondary AI nZ195). AI patients showed significantly impaired SHS compared with controls irrespective of the glucocorticoid used for replacement. The only difference in SHS between patients on prednisolone (PR) and hydrocortisone (all patients and sub-analysis for primary AI) was significant higher bodily pain (lower Z-score in SF-36) in patients on PR (P!0.05, P!0.01 respectively). In patients with secondary AI, the PR group showed significantly (P!0.05) less heart complaints (lower Z-score) in the GBB questionnaire compared with the cortisone acetate group. Conclusions: Glucocorticoid replacement therapy with PR seems to be equivalent to hydrocortisone regarding SHS in patients with AI. However, SHS remains impaired in all patient groups suggesting a need for further improved glucocorticoid replacement strategies.European Journal of Endocrinology 159 811-817

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Premature Mortality in Patients with Addison’s Disease: A Population-Based Study

Abstract: Compared with the background population, we observed that the risk ratio for death was more than 2-fold higher in patients with Addison's disease. Cardiovascular, malignant, and infectious diseases were responsible for the higher mortality rate.

Cited by 444 publications

References 26 publications

Improvement of anthropometric and metabolic parameters, and quality of life following treatment with dual-release hydrocortisone in patients with Addison’s disease

Improvement of anthropometric and metabolic parameters, and quality of life following treatment with dual-release hydrocortisone in patients with Addison’s disease

Adrenal Crisis: Still a Deadly Event in the 21st Century

Impaired subjective health status in chronic adrenal insufficiency: impact of different glucocorticoid replacement regimens

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