Wednesday, October 14, 2009

Adrenal crisis in treated Addison’s disease: a predictable but under-managed event

K White, Clinical Advisory Panel, Addison's Disease Self-Help Group, Hertford, SG13 8AZ, United Kingdom
W Arlt, Division of Medical Sciences, University of Birmingham College of Medical and Dental Sciences, Birmingham, United Kingdom

Katherine White, Email: kgwhite@addisons.org.uk

Context

Adrenal crisis is a life-threatening event that occurs regularly in Addison’s patients receiving standard replacement therapy. Patient reports suggest that it is an under-estimated and under-managed event.

Objective

To assess the frequency of adrenal crisis is diagnosed patients and to understand the factors contributing to the risks of adrenal crisis.

Design

We conducted a postal survey of Addison’s patients in four countries (UK N=485, Canada (N=148), Australia (N= 1237) and New Zealand (N=85) in 2003, asking about patients’ experiences of adrenal crisis and their demographic characteristics. In 2006 a shorter, follow-up survey was conducted in the UK (N=261).

Method

The frequency and causes of adrenal crisis were compared across both surveys. Demographic data from the 2003 survey was analysed to establish the main variables associated with an elevated risk of crisis.

Results

Around 8% of diagnosed cases can be expected to need hospital treatment for adrenal crisis annually, with exposure to gastric infection the single most important factor predicting the likelihood of adrenal crisis. Concomitant diabetes and/or asthma increase the frequency of adrenal crises reported by patients.

Conclusion

The endocrinologist has a responsibility to ensure that Addison’s patients have adequate access to life-saving emergency injection materials and repeated, practical training sessions in how to use them, while the GP plays a vital role as in arranging prompt emergency admissions.

From http://www.eje.org/cgi/content/abstract/EJE-09-0559v1