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Mortality data from the European Adrenal Insufficiency RegistryPatient characterization and associations
Endocrinol Charlottenburg, Germany.
Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Endocrinology.
Shire, MA USA.
Sapienza Univ Rome, Italy.
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2018 (English)In: Clinical Endocrinology, ISSN 0300-0664, E-ISSN 1365-2265, Vol. 89, no 1, p. 30-35Article in journal (Refereed) Published
Abstract [en]

ObjectiveMortality from primary and secondary adrenal insufficiency (AI; PAI and SAI, respectively) is 2-3-fold higher than in the general population. Mortality relates to cardiovascular disease, acute adrenal crisis (AC), cancer and infections; however, there has been little further characterization of patients who have died. Design/MethodsWe analysed real-world data from 2034 patients (801 PAI, 1233 SAI) in the European Adrenal Insufficiency Registry (EU-AIR; NCT01661387). Baseline clinical and biochemical data of patients who subsequently died were compared with those who remained alive. ResultsFrom August 2012 to June 2017, 26 deaths occurred (8 PAI, 18 SAI) from cardiovascular disease (n=9), infection (n=4), suicide (n=2), drug-induced hepatitis (n=2), and renal failure, brain tumour, cachexia and AC (each n=1); cause of death was unclear in 5 patients. Patients who died were significantly older at baseline than alive patients. Causes of AI were representative of patients with SAI; however, 3-quarters of deceased patients with PAI had undergone bilateral adrenalectomy (3 with uncontrolled Cushings disease, 3 with metastatic renal cell cancer). There were no significant differences in body mass index, blood pressure, low-density lipoprotein cholesterol, total cholesterol or electrolytes between deceased and alive patients. Deceased patients with SAI were more frequently male individuals, were receiving higher daily doses of hydrocortisone (24.07.6 vs 19.3 +/- 5.7mg, P=.0016) and experienced more frequent ACs (11.1 vs 2.49/100 patient-years, P=.0389) than alive patients. ConclusionsThis is the first study to provide detailed characteristics of deceased patients with AI. Older, male patients with SAI and frequent AC had a high mortality risk.

Place, publisher, year, edition, pages
WILEY , 2018. Vol. 89, no 1, p. 30-35
Keywords [en]
adrenal hyperplasia; adrenal insufficiency; cardiovascular diseases; cause of death; glucocorticoids; hydrocortisone; registries
National Category
Anesthesiology and Intensive Care
Identifiers
URN: urn:nbn:se:liu:diva-149470DOI: 10.1111/cen.13609ISI: 000435081200004PubMedID: 29682773OAI: oai:DiVA.org:liu-149470DiVA, id: diva2:1231085
Note

Funding Agencies|Shire

Available from: 2018-07-05 Created: 2018-07-05 Last updated: 2018-08-02

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