title: Modern Hydrocortisone Replacement Regimens in Adrenal Insufficiency Patients and the Risk of Adrenal Crisis.
abstract: The aim of this study was to examine the incidence of adrenal crises (AC) and the prescription of short-acting glucocorticoids (GC) in different geographic areas. To do this we conducted a descriptive study of AC hospitalisations and prescriptions for two GCs (hydrocortisone (HC) and cortisone acetate (CA)), and fludrocortisone acetate (FA), in different geographic areas of Australia between 1999/2000 and 2011/2012, using government databases.There were 2,584 hospital admissions for AC in Australia between 1999/00 and 2011/12 and the corresponding admission rates increased significantly from 7.4 to 11.1/10(6)/year (p<0.001). AC admission rates increased in 5 out of 6 geographic areas. Prescription rates for the combined GCs (HC/CA) increased at an annual rate of between 0.2-2.0% in all areas. All areas had significant (p<0.01) increases in HC prescription rates (4.5% to 13.7% annually) and CA prescription rates decreased in 5 out of the 6 regions (3.5% annual decrease to a 0.5% annual increase). When the geographic areas were combined, there was a significant correlation between the AC admission rates and HC/CA prescription rates (r=0.30, p<0.01). Admissions for AC and GC prescriptions increased significantly in Australia after 1999 and these varied significantly by geographic area. These results suggest that modern recommendations for lower dose, short-acting GC replacement may be of concern and further investigation is warranted.
authors.affiliation: School of Medicine, Sydney, The University of Notre Dame, Australia, Darlinghurst, Australia.
authors.forename: R L
authors.initials: RL
authors.lastname: Rushworth
authors.affiliation: Endocrine and Metabolic Unit, Royal Adelaide Hospital and University of Adelaide North Terrace, Adelaide, Australia.
authors.forename: D J
authors.initials: DJ
authors.lastname: Torpy
mesh_terms: D000208:Acute Disease / Q000453:epidemiology*; D000309:Adrenal Insufficiency / Q000188:drug therapy* / Q000453:epidemiology; D001315:Australia / Q000453:epidemiology; D003348:Cortisone / Q000031:analogs & derivatives / Q000627:therapeutic use; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005938:Glucocorticoids / Q000627:therapeutic use*; D020249:Hormone Replacement Therapy / Q000592:standards / Q000706:statistics & numerical data* / Q000639:trends; D006760:Hospitalization / Q000706:statistics & numerical data / Q000639:trends; D006801:Humans; D006854:Hydrocortisone / Q000627:therapeutic use*; D015994:Incidence; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012306:Risk
chemical_list: D005938:Glucocorticoids; D003348:Cortisone; D006854:Hydrocortisone