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Mortality data from the European Adrenal Insufficiency Registry—Patient characterization and associations
Author(s) -
Quinkler Marcus,
Ekman Bertil,
Zhang Pinggao,
Isidori Andrea M.,
Murray Robert D.
Publication year - 2018
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1111/cen.13609
Subject(s) - adrenal insufficiency , medicine , endocrinology
Summary Objective Mortality 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/Methods We analysed real‐world data from 2034 patients (801 PAI , 1233 SAI ) in the European Adrenal Insufficiency Registry ( EU ‐ AIR ; NCT 01661387). Baseline clinical and biochemical data of patients who subsequently died were compared with those who remained alive. Results From 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 Cushing's 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 (24.0 ± 7.6 vs 19.3 ± 5.7 mg, P = .0016) and experienced more frequent AC s (11.1 vs 2.49/100 patient‐years, P = .0389) than alive patients. Conclusions This 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.