The epidemiology of primary and secondary adrenal malignancies and associated adrenal insufficiency in hospitalised patients: an analysis of hospital admission data, NSW, Australia

Abstract

Background Adrenal insufficiency (AI) causes considerable morbidity but may remain undiagnosed in patients with adrenal malignancy (AM). The epidemiology of AI and adrenal crises (AC) in AM is uncertain. Methods This was a retrospective study examining hospital admission data from 2006 to 2017. All admissions to all hospitals in NSW, Australia over this period with a principal or comorbid diagnosis of an adrenal malignancy were selected. Data were examined for trends in admissions for AM and associated AI/AC using population data from the corresponding years. Results There were 15,376 hospital admissions with a diagnosis of AM in NSW over the study period, corresponding to 1281 admissions/year. The AM admission rate increased significantly over the study period from 129.9/million to 215.7/million (p < 0.01). An AI diagnosis was recorded in 182 (1.2%) admissions, corresponding to an average of 2.1/million/year. This rate increased significantly over the years of the study from 1.2/million in 2006 to 3.4/million in 2017 (p < 0.01). An AC was identified in 24 (13.2%) admissions with an AI diagnosis. Four patients (16.7%) with an AC died during the hospitalisation. Conclusion Admission with a diagnosis of AM has increased over recent years and has been accompanied by an increase in AI diagnoses. While AI is diagnosed in a small proportion of patients with AM, ACs do occur in affected patients.

Specialty grand challenge in adrenal endocrinology

“…Novel forms of PAI have emerged such as immune checkpoint inhibitor (ICI) induced PAI, even though ICIs more commonly induce secondary AI ( 5 ). Bilateral adrenal metastasis and bilateral adrenal hemorrhage may result in PAI ( 6 , 7 ). It is estimated that 10-20/100,000 of the population have PAI ( 2 ).…”

The Changing Epidemiology of Adrenal Insufficiency: Iatrogenic Factors Predominate

“…In Western countries, autoimmune disorders and pituitary adenomas (and their treatment) are common causes of AI, while infections (tuberculosis and HIV) predominate in low- to middle-income populations [ 7-9 ]. Malignancies (primary or secondary tumors of the adrenal or pituitary glands) can occur at any age, with adrenal metastases being more common in older patients [ 10 ]. Iatrogenic AI can follow exposure to therapeutic doses of GCs, including inhaled GCs, or opioid use and is often undiagnosed [ 11 , 12 ].…”