title: Incidence of adrenal crisis in patients with adrenal insufficiency.
abstract: BACKGROUND
  An adrenal crisis (AC) is a potential life-threatening event in patients with adrenal insufficiency (AI). This study aims to determine the incidence, causes, and risk factors of AC in AI.
  
  
  METHODS
  Patients with AI diagnosed and treated at the University Medical Center Utrecht for the past 30 years were identified, and all medical records were assessed by two independent investigators. The observed frequency of AC was determined as incidence rate, calculated as the number of AC divided by person-years (PY). In addition, precipitating factors and risk factors were assessed.
  
  
  RESULTS
  We observed an incidence rate of 5·2 AC (95% CI 4·3-6·3) per 100 PY in primary adrenal insufficiency (PAI, a total of 111 patients), and 3·6 AC (95% CI 3·1-4·1) per 100 PY in secondary adrenal insufficiency (SAI a total of 319 patients). Patients with an established diagnosis of tertiary (glucocorticoid-induced) adrenal insufficiency (a total of 28 patients) had 15·1 AC (95% CI 11·0-19·9) per 100 PY. The most important risk factor was the existence of comorbidity. Gastro-enteritis and other infections were the most common precipitating factors for AC.
  
  
  CONCLUSIONS
  AC still occurs relatively frequent in patients with AI, mostly precipitated by infections and particularly in patients with high comorbidity. This should be taken into account in the education and follow-up of patients with AI.
authors.affiliation: Department of Internal Medicine and Endocrinology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Lisanne C C J
authors.initials: LC
authors.lastname: Smans
authors.affiliation: Department of Internal Medicine and Endocrinology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Eline S
authors.initials: ES
authors.lastname: Van der Valk
authors.affiliation: Department of Internal Medicine, Division of Endocrinology, Radboud University Nijmegen Medical Center, The Netherlands.
authors.forename: Ad R M M
authors.initials: AR
authors.lastname: Hermus
authors.affiliation: Department of Internal Medicine and Endocrinology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Pierre M J
authors.initials: PM
authors.lastname: Zelissen
mesh_terms: D000224:Addison Disease / Q000175:diagnosis / Q000453:epidemiology*; D000312:Adrenal Hyperplasia, Congenital / Q000175:diagnosis / Q000453:epidemiology*; D000309:Adrenal Insufficiency / Q000453:epidemiology*; D000328:Adult; D000368:Aged; D015897:Comorbidity; D005260:Female; D005759:Gastroenteritis / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007239:Infections / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands / Q000453:epidemiology; D018570:Risk Assessment / Q000379:methods / Q000706:statistics & numerical data*; D012307:Risk Factors