Morbidity in Patients with Chronic Adrenal Insufficiency - Cardiovascular Risk Factors and Hospitalization Rate Compared to Population Based Controls.

Patients with adrenal insufficiency (AI) have been found to have increased cardiovascular morbidity, partly associated with nonphysiologic glucocorticoid replacement. We included two separate cohorts (cohort 1 and 2) of patients with chronic primary and secondary AI under standard replacement therapy and compared them to two age- and sex-matched population-based studies (SHIP-TREND/DEGS). Patient cohort 1 comprised 384 individuals assessed by questionnaires, cohort 2 included 180 patients participating in a longitudinal patient registry. Odds ratios with 95% CI for hypertension, hyperlipidaemia/HLP, type 2 diabetes/T2DM, obesity and hospitalization with adjustment for confounders were evaluated by logistic regression Patient cohort 1 had significantly lower ORs for obesity (0.4 (0.3-0.6), p<0.001) and hypertension (0.5 (0.3-0.6), p<0.001) compared to SHIP-TREND and for obesity (0.7 (0.5-0.9), p=0.01), hypertension (0.4 (0.3-0.5), p<0.001) and HLP (0.4 (0.3-0.6), p<0.001) compared to DEGS. In cohort 2, ORs were significantly lower for HLP compared to both SHIP-TREND (0.4 (0.2-0.7), p=0.001) and DEGS (0.3 (0.2-0.5), p<0.001) and for hypertension (0.7 (0.4-0.9), p=0.04) compared to SHIP-TREND. In patients with SAI from cohort 2, ORs for DM2 (2.5 (1.3-4.9) p=0.009), hypertension (2.5 (1.4-4.5), p=0.002) and obesity (1.9 (1.1-3.1), p=0.02) were significantly higher compared to DEGS, whereas ORs for HLP were significantly lower compared to both SHIP (0.3 (0.1-0.6), p=0.002) and DEGS (0.3 (0.1-0.6), p<0.001). ORs for hospitalization were significantly higher in both patient cohorts. In most of our AI patients treated with conventional glucocorticoid doses, the risk for T2DM, obesity, hypertension, and HLP was not increased. The number of hospitalizations was significantly higher in AI patients compared to controls, which might reflect increased susceptibility but also a more proactive management of concomitant diseases by physicians and patients.