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Horm Metab Res 2024; 56(01): 20-29
DOI: 10.1055/a-2190-3735
Original Article: Endocrine Care

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

Irina Chifu
1   Endocrinology and Diabetes Unit, Department of Medicine I, University of Wuerzburg, Wuerzburg, Germany
,
Marcus Quinkler 
2   Endocrinology in Charlottenburg/Berlin, Berlin, Germany
,
Barbara Altieri
1   Endocrinology and Diabetes Unit, Department of Medicine I, University of Wuerzburg, Wuerzburg, Germany
,
Anke Hannemann
3   Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
,
Henry Völzke
4   Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
,
Katharina Lang
1   Endocrinology and Diabetes Unit, Department of Medicine I, University of Wuerzburg, Wuerzburg, Germany
2   Endocrinology in Charlottenburg/Berlin, Berlin, Germany
,
Nicole Reisch
5   Department of Endocrine Research, Department of Medicine IV, Ludwig-Maximilians-University, Munich, Germany
,
Christina Pamporaki
6   Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
,
Holger Sven Willenberg 
7   Division of Endocrinology and Metabolism, Rostock University Medical Center, Germany
,
Felix Beuschlein 
5   Department of Endocrine Research, Department of Medicine IV, Ludwig-Maximilians-University, Munich, Germany
8   Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich (USZ), and University of Zurich (UZH), Zurich, Switzerland
9   LOOP Zurich – Medical Research Center, Zurich, Switzerland
,
Stephanie Burger-Stritt‡
1   Endocrinology and Diabetes Unit, Department of Medicine I, University of Wuerzburg, Wuerzburg, Germany
,
Stefanie Hahner‡
1   Endocrinology and Diabetes Unit, Department of Medicine I, University of Wuerzburg, Wuerzburg, Germany
› Institutsangaben Funding Information Deutsche Forschungsgemeinschaft (CRC/Transregio 205 “The Adrenal: Central Relay in Health and Disease”, project number 314061271). Else Kröner-Fresenius Stiftung and the Eva Luise Köhler Stiftung.
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Abstract

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 n=384 patients, cohort 2 n=180 patients) 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). Odds ratios with 95% CI for hypertension, hyperlipidemia/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]. 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.

Key words

adrenal insufficiency - hyperlipidaemia - hypertension - obesity, metabolic syndrome - cardiovascular risk factors - hospitalization

Supplementary Material



Publikationsverlauf

Eingereicht: 12. Juli 2023

Angenommen nach Revision: 11. Oktober 2023

Accepted Manuscript online:
12. Oktober 2023

Artikel online veröffentlicht:
03. Januar 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Bergthorsdottir R, Leonsson-Zachrisson M, Odén A. et al. Premature mortality in patients with Addison’s disease: a population-based study. J Clin Endocrinol Metab 2006; 91: 4849-4853
    CrossrefPubMedGoogle Scholar
  • 2 Burger-Stritt S, Pulzer A, Hahner S. Quality of life and life expectancy in patients with adrenal insufficiency: what is true and what is urban myth?. Front Horm Res 2016; 46: 171-183
    CrossrefPubMedGoogle Scholar
  • 3 Erichsen MM, Løvås K, Skinningsrud B. et al. Clinical, immunological, and genetic features of autoimmune primary adrenal insufficiency: observations from a Norwegian registry. J Clin Endocrinol Metab 2009; 94: 4882-4890
    CrossrefPubMedGoogle Scholar
  • 4 Ngaosuwan K, Johnston DG, Godsland IF. et al. Increased mortality risk in patients with primary and secondary adrenal insufficiency. J Clin Endocrinol Metab 2021; 106: e2759-e2768
    CrossrefPubMedGoogle Scholar
  • 5 Ngaosuwan K, Johnston DG, Godsland IF. et al. Cardiovascular disease in patients with primary and secondary adrenal insufficiency and the role of comorbidities. J Clin Endocrinol Metab 2021; 106: 1284-1293
    CrossrefPubMedGoogle Scholar
  • 6 Filipsson H, Monson JP, Koltowska-Häggström M. et al. The impact of glucocorticoid replacement regimens on metabolic outcome and comorbidity in hypopituitary patients. J Clin Endocrinol Metab 2006; 91: 3954-3961
    CrossrefPubMedGoogle Scholar
  • 7 Skov J, Sundström A, Ludvigsson JF. et al. Sex-specific risk of cardiovascular disease in autoimmune addison disease - a population-based cohort study. J Clin Endocrinol Metab 2019; 104: 2031-2040
    CrossrefPubMedGoogle Scholar
  • 8 Stewart PM, Biller BM, Marelli C. et al. Exploring inpatient hospitalizations and morbidity in patients with adrenal insufficiency. J Clin Endocrinol Metab 2016; 101: 4843-4850
    CrossrefPubMedGoogle Scholar
  • 9 Quinkler M, Ekman B, Zhang P. et al. Mortality data from the European Adrenal Insufficiency Registry - patient characterization and associations. Clin Endocrinol 2018; 89: 30-35
    CrossrefPubMedGoogle Scholar
  • 10 Giordano R, Marzotti S, Balbo M. et al. Metabolic and cardiovascular profile in patients with Addison’s disease under conventional glucocorticoid replacement. J Endocrinol Invest 2009; 32: 917-923
    CrossrefPubMedGoogle Scholar
  • 11 Debono M, Ross RJ. What is the best approach to tailoring hydrocortisone dose to meet patient needs in 2012?. Clin Endocrinol 2013; 78: 659-664
    CrossrefPubMedGoogle Scholar
  • 12 Bergthorsdottir R, Ragnarsson O, Skrtic S. et al. Visceral fat and novel biomarkers of cardiovascular disease in patients with Addison’s disease: a case-control study. J Clin Endocrinol Metab 2017; 102: 4264-4272
    CrossrefPubMedGoogle Scholar
  • 13 Frey KR, Kienitz T, Schulz J. et al. Prednisolone is associated with a worse bone mineral density in primary adrenal insufficiency. Endocr Connect 2018; 7: 811-818
    CrossrefPubMedGoogle Scholar
  • 14 Hahner S, Spinnler C, Fassnacht M. et al. High incidence of adrenal crisis in educated patients with chronic adrenal insufficiency: a prospective study. J Clin Endocrinol Metab 2015; 100: 407-416
    CrossrefPubMedGoogle Scholar
  • 15 Gößwald A, Lange M, Kamtsiuris P. et al. [DEGS: German Health Interview and Examination Survey for Adults. A nationwide cross-sectional and longitudinal study within the framework of health monitoring conducted by the Robert Koch Institute]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2012; 55: 775-780
    PubMedGoogle Scholar
  • 16 Völzke H. [Study of health in Pomerania (SHIP). Concept, design and selected results]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2012; 55: 790-794
    PubMedGoogle Scholar
  • 17 Völzke H, Alte D, Schmidt CO. et al. Cohort profile: the study of health in Pomerania. Int J Epidemiol 2011; 40: 294-307
    CrossrefPubMedGoogle Scholar
  • 18 Dineen R, Martin-Grace J, Ahmed KMS. et al. Cardiometabolic and psychological effects of dual-release hydrocortisone: a cross-over study. Eur J Endocrinol 2021; 184: 253-265
    CrossrefPubMedGoogle Scholar
  • 19 Dunne FP, Elliot P, Gammage MD. et al. Cardiovascular function and glucocorticoid replacement in patients with hypopituitarism. Clin Endocrinol (Oxf) 1995; 43: 623-629
    CrossrefPubMedGoogle Scholar
  • 20 Vulto A, Bergthorsdottir R, van Faassen M. et al. Residual endogenous corticosteroid production in patients with adrenal insufficiency. Clin Endocrinol (Oxf) 2019; 91: 383-390
    CrossrefPubMedGoogle Scholar
  • 21 Ebrahimi F, Widmer A, Wagner U. et al. Association of adrenal insufficiency with patient-oriented health-care outcomes in adult medical inpatients. Eur J Endocrinol 2019; 181: 701-709
    CrossrefPubMedGoogle Scholar
  • 22 Bancos I, Hazeldine J, Chortis V. et al. Primary adrenal insufficiency is associated with impaired natural killer cell function: a potential link to increased mortality. Eur J Endocrinol 2017; 176: 471-480
    CrossrefPubMedGoogle Scholar