Exploring Inpatient Hospitalizations and Morbidity in Patients With Adrenal Insufficiency.
Patients with adrenal insufficiency (AI) (primary AI [PAI], secondary AI due to a pituitary disorder [PIT] and congenital adrenal hyperplasia [CAH]) have reduced life expectancy; however, the underlying explanation remains unknown.



To evaluate characteristics, comorbidities, and hospitalizations in AI patients.



Retrospective observational.



Using a United States-based national payer database comprising of more than 108 million members, strict inclusion criteria including diagnostic codes and steroid prescription records were used to identify 10 383 adults with AI; 1014 with PAI, 8818 with PIT, and 551 with CAH. Patients were matched 1:1 to controls, based on age (±5 y), gender, insurance, and region and followed for more than 12 months.



None.



Demographic variables, comorbidities (diabetes mellitus [DM] types 1 and 2, depression, anxiety, hyperlipidemia, hypertension) and hospitalization incidence.



Compared with controls, patients with AI had higher odds of DM, hypertension, hyperlipidaemia, depression, and anxiety, ranging from an odds ratio (OR) of 1.51 for hyperlipidaemia in PAI to 3.85 for DM in CAH. Odds of having DM (OR, 3.85; 95% confidence interval, 2.52-5.90) or anxiety (OR, 2.99; 95% confidence interval, 2.02-4.42) compared with controls were highest in CAH, whereas depression was highest in PAI and PIT (OR, 2.40 and 2.55). ORs of hyperlipidaemia and hypertension (OR, 1.98 and 2.24) were highest in the PIT cohort. Inpatient admissions were more frequent in PAI (4.64:1; P < .0001) and PIT (4.00:1; P < .0001) than controls; infection was the most common cause for admission.



Patients with AI carry a significant metabolic and psychiatric burden, with higher risk of comorbidities and hospital admissions than matched controls.
Medical School (P.M.S.), University of Leeds, Leeds LS2 9NL, United Kingdom; Neuroendocrine Unit (B.M.K.B.), Massachusetts General Hospital, Boston, Massachusetts; Shire (C.M.), 6300 Zug, Switzerland; CTI Clinical Trial and Consulting Services, Inc (C.G., M.P.R.), Cincinnati, Ohio 45212; and Department of Internal Medicine and Clinical Nutrition (G.J.), Institute of Medicine, Sahlgrenska Academy, University of Göteborg and Department of Endocrinology, Sahlgrenska University Hospital, Göteborg SE-413 45, Sweden.
Paul M
PM
Stewart
Medical School (P.M.S.), University of Leeds, Leeds LS2 9NL, United Kingdom; Neuroendocrine Unit (B.M.K.B.), Massachusetts General Hospital, Boston, Massachusetts; Shire (C.M.), 6300 Zug, Switzerland; CTI Clinical Trial and Consulting Services, Inc (C.G., M.P.R.), Cincinnati, Ohio 45212; and Department of Internal Medicine and Clinical Nutrition (G.J.), Institute of Medicine, Sahlgrenska Academy, University of Göteborg and Department of Endocrinology, Sahlgrenska University Hospital, Göteborg SE-413 45, Sweden.
Beverly M K
BM
Biller
Medical School (P.M.S.), University of Leeds, Leeds LS2 9NL, United Kingdom; Neuroendocrine Unit (B.M.K.B.), Massachusetts General Hospital, Boston, Massachusetts; Shire (C.M.), 6300 Zug, Switzerland; CTI Clinical Trial and Consulting Services, Inc (C.G., M.P.R.), Cincinnati, Ohio 45212; and Department of Internal Medicine and Clinical Nutrition (G.J.), Institute of Medicine, Sahlgrenska Academy, University of Göteborg and Department of Endocrinology, Sahlgrenska University Hospital, Göteborg SE-413 45, Sweden.
Claudio
C
Marelli
Medical School (P.M.S.), University of Leeds, Leeds LS2 9NL, United Kingdom; Neuroendocrine Unit (B.M.K.B.), Massachusetts General Hospital, Boston, Massachusetts; Shire (C.M.), 6300 Zug, Switzerland; CTI Clinical Trial and Consulting Services, Inc (C.G., M.P.R.), Cincinnati, Ohio 45212; and Department of Internal Medicine and Clinical Nutrition (G.J.), Institute of Medicine, Sahlgrenska Academy, University of Göteborg and Department of Endocrinology, Sahlgrenska University Hospital, Göteborg SE-413 45, Sweden.
Candace
C
Gunnarsson
Medical School (P.M.S.), University of Leeds, Leeds LS2 9NL, United Kingdom; Neuroendocrine Unit (B.M.K.B.), Massachusetts General Hospital, Boston, Massachusetts; Shire (C.M.), 6300 Zug, Switzerland; CTI Clinical Trial and Consulting Services, Inc (C.G., M.P.R.), Cincinnati, Ohio 45212; and Department of Internal Medicine and Clinical Nutrition (G.J.), Institute of Medicine, Sahlgrenska Academy, University of Göteborg and Department of Endocrinology, Sahlgrenska University Hospital, Göteborg SE-413 45, Sweden.
Michael P
MP
Ryan
Medical School (P.M.S.), University of Leeds, Leeds LS2 9NL, United Kingdom; Neuroendocrine Unit (B.M.K.B.), Massachusetts General Hospital, Boston, Massachusetts; Shire (C.M.), 6300 Zug, Switzerland; CTI Clinical Trial and Consulting Services, Inc (C.G., M.P.R.), Cincinnati, Ohio 45212; and Department of Internal Medicine and Clinical Nutrition (G.J.), Institute of Medicine, Sahlgrenska Academy, University of Göteborg and Department of Endocrinology, Sahlgrenska University Hospital, Göteborg SE-413 45, Sweden.
Gudmundur
G
Johannsson
D000293:Adolescent; D000312:Adrenal Hyperplasia, Congenital / Q000453:epidemiology*; D000309:Adrenal Insufficiency / Q000453:epidemiology* / Q000209:etiology; D000328:Adult; D000368:Aged; D001007:Anxiety / Q000453:epidemiology*; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology*; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D006949:Hyperlipidemias / Q000453:epidemiology*; D006973:Hypertension / Q000453:epidemiology*; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D010900:Pituitary Diseases / Q000150:complications / Q000453:epidemiology; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D055815:Young Adult