Impaired subjective health status in 256 patients with adrenal insufficiency on standard therapy based on cross-sectional analysis.
BACKGROUND
There is mounting evidence that current replacement regimens fail to restore health-related subjective health status fully in patients with adrenal insufficiency (AI). Here we evaluated the subjective health status in primary and secondary AI and the effect of concomitant disease.


METHODS
In a cross-sectional study, all AI patients registered with the University Hospital Wuerzburg (n = 148) or with the German Self-Help Network (n = 200) were contacted by mail. Underlying diagnoses and comorbidities were verified by review of medical records. Patients were asked to complete three validated self-assessment questionnaires [Short Form 36 (SF-36), Giessen Complaint List (GBB-24), Hospital Anxiety and Depression Scale (HADS)]. Results were compared to sex- and age-matched controls drawn from the questionnaire-specific reference cohorts.


RESULTS
We identified 348 patients, and 256 agreed to participate. Completed questionnaire sets were available from 210 patients [primary AI (n = 132), secondary AI (n = 78)]. Seven of eight SF-36 dimensions, all five GBB-24 scales, and the HADS anxiety score reflected significant impairment of subjective health status in both AI cohorts (all P < 0.001). Even after exclusion of all patients with any concomitant disease, subjective health status remained significantly impaired in five SF-36 subscales and four GBB-24 subscales. Secondary AI patients were slightly more compromised than primary AI, significant with regard to two SF-36 scales (P < 0.05) and the HADS depression score (P < 0.001). A total of 18.3% of the AI patients were out of work, compared to 4.1% in the general population.


CONCLUSIONS
Patients with AI on current standard replacement suffer from significantly impaired health-related subjective health status, irrespective of origin of disease or concomitant disease. Future studies will have to assess whether more physiological glucocorticoid replacement strategies in AI will ameliorate these impairments.
Endocrinology and Diabetes Unit, Department of Medicine I, University of Wuerzburg, Josef-Schneider-Strasse 2, D-97080 Wuerzburg, Germany.
Stefanie
S
Hahner
Melanie
M
Loeffler
Martin
M
Fassnacht
Dirk
D
Weismann
Ann-Cathrin
AC
Koschker
Marcus
M
Quinkler
Oliver
O
Decker
Wiebke
W
Arlt
Bruno
B
Allolio
D000203:Activities of Daily Living; D000309:Adrenal Insufficiency / Q000188:drug therapy* / Q000453:epidemiology* / Q000523:psychology; D000328:Adult; D000368:Aged; D001007:Anxiety / Q000453:epidemiology; D015331:Cohort Studies; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006304:Health Status; D020249:Hormone Replacement Therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009790:Occupations; D011594:Psychometrics; D011795:Surveys and Questionnaires
D005938:Glucocorticoids