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

Irina Chifu; Marcus Quinkler; Barbara Altieri; Anke Hannemann; Henry Völzke; Katharina Lang; Nicole Reisch; Christina Pamporaki; Holger Sven Willenberg; Felix Beuschlein; Stephanie Burger-Stritt; Stefanie Hahner

doi:10.1055/a-2190-3735

Hormone and Metabolic Research, Inhaltsverzeichnis

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

¹Endocrinology and Diabetes Unit, Department of Medicine I, University of Wuerzburg, Wuerzburg, Germany

,

Marcus Quinkler

²Endocrinology in Charlottenburg/Berlin, Berlin, Germany

,

Barbara Altieri

¹Endocrinology and Diabetes Unit, Department of Medicine I, University of Wuerzburg, Wuerzburg, Germany

,

Anke Hannemann

³Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany

,

Henry Völzke

⁴Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany

,

Katharina Lang

¹Endocrinology and Diabetes Unit, Department of Medicine I, University of Wuerzburg, Wuerzburg, Germany

²Endocrinology in Charlottenburg/Berlin, Berlin, Germany

,

Nicole Reisch

⁵Department of Endocrine Research, Department of Medicine IV, Ludwig-Maximilians-University, Munich, Germany

,

Christina Pamporaki

⁶Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany

,

Holger Sven Willenberg

⁷Division of Endocrinology and Metabolism, Rostock University Medical Center, Germany

,

Felix Beuschlein

⁵Department of Endocrine Research, Department of Medicine IV, Ludwig-Maximilians-University, Munich, Germany

⁸Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich (USZ), and University of Zurich (UZH), Zurich, Switzerland

⁹LOOP Zurich – Medical Research Center, Zurich, Switzerland

,

Stephanie Burger-Stritt‡

¹Endocrinology and Diabetes Unit, Department of Medicine I, University of Wuerzburg, Wuerzburg, Germany

,

Stefanie Hahner‡

¹Endocrinology and Diabetes Unit, Department of Medicine I, University of Wuerzburg, Wuerzburg, Germany

› Institutsangaben

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

Volltext

Referenzen

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