| Popis: |
Context: Adrenal insufficiency (AI) is associated with reduced life expectancy and increased morbidity even after glucocorticoid replacement therapy. Aim Our aim was to assess the co-morbid burden of AI in a United Kingdom-based population. Methods We retrospectively studied patients diagnosed between 1996 and 2014 (minimum disease duration 12 months) with primary (PAI; n=55 [23 females]; CAH excluded) and secondary AI (SAI; n=79 [29 females]; Cushing’s syndrome and acromegaly excluded) using an electronic patient database (n=352000) in North West England. Patients with AI were identified by diagnostic codes and glucocorticoid prescriptions. Each patient with PAI or SAI was matched to non-AI patients with the same gender and date of birth (control cohort n=35172). Outcome measures were change in weight, prevalence of co-morbid illness (type 2 diabetes [T2D], prediabetes, hypertension, cardiovascular disease [CVD] and osteoporosis) and hospital admissions during the study period. Results In PAI, 91% of patients were treated with hydrocortisone (mean dose 23 ±8 mg) and 9% with prednisolone (mean dose 3 ±2 mg). In SAI, 94% of patients were treated with hydrocortisone (mean dose 18 ±8 mg) and 5% with prednisolone (mean dose 6 ±3 mg). The annual weight change compared to controls was significantly higher in PAI (median 1.16 kg [0.15-2.96], vs -0.01 kg [-0.49 – 0.41]; P=0.001) and SAI (median 0.55 kg [-1.49 – 1.57] vs median -0.47 kg [-0.99 – 0.32]; P=0.045). When comparing the weight at the time of diagnosis to the last available weight in the study period, a higher proportion of patients were within the overweight/obese category (BMI ≥ 25 kg/m2) for PAI (38% [baseline] vs 70% [study end]; P=0.028) but not SAI (85% [baseline] vs 73% [study end]; P=0.327) and controls (65% [baseline] vs 56% [study end]; P=0.218). For PAI, the prevalence of prediabetes (22% vs 10%), T2D (9% vs 5%), hypertension (38% vs 30%) and CVD (9% vs 5%) was significantly (p |
