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Horm Metab Res 2024; 56(01): 20-29
DOI: 10.1055/a-2190-3735
Original Article: Endocrine Care

Morbidity in Patients with Chronic Adrenal Insufficiency – Cardiovascular Risk Factors and Hospitalization Rate Compared to Population Based Controls

Irina Chifu
1   Endocrinology and Diabetes Unit, Department of Medicine I, University of Wuerzburg, Wuerzburg, Germany
,
Marcus Quinkler 
2   Endocrinology in Charlottenburg/Berlin, Berlin, Germany
,
Barbara Altieri
1   Endocrinology and Diabetes Unit, Department of Medicine I, University of Wuerzburg, Wuerzburg, Germany
,
Anke Hannemann
3   Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
,
Henry Völzke
4   Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
,
Katharina Lang
1   Endocrinology and Diabetes Unit, Department of Medicine I, University of Wuerzburg, Wuerzburg, Germany
2   Endocrinology in Charlottenburg/Berlin, Berlin, Germany
,
Nicole Reisch
5   Department of Endocrine Research, Department of Medicine IV, Ludwig-Maximilians-University, Munich, Germany
,
Christina Pamporaki
6   Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
,
Holger Sven Willenberg 
7   Division of Endocrinology and Metabolism, Rostock University Medical Center, Germany
,
Felix Beuschlein 
5   Department of Endocrine Research, Department of Medicine IV, Ludwig-Maximilians-University, Munich, Germany
8   Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich (USZ), and University of Zurich (UZH), Zurich, Switzerland
9   LOOP Zurich – Medical Research Center, Zurich, Switzerland
,
Stephanie Burger-Stritt‡
1   Endocrinology and Diabetes Unit, Department of Medicine I, University of Wuerzburg, Wuerzburg, Germany
,
Stefanie Hahner‡
1   Endocrinology and Diabetes Unit, Department of Medicine I, University of Wuerzburg, Wuerzburg, Germany
› Author Affiliations Funding Information Deutsche Forschungsgemeinschaft (CRC/Transregio 205 “The Adrenal: Central Relay in Health and Disease”, project number 314061271). Else Kröner-Fresenius Stiftung and the Eva Luise Köhler Stiftung.
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Abstract

Patients with adrenal insufficiency (AI) have been found to have increased cardiovascular morbidity, partly associated with nonphysiologic glucocorticoid replacement. We included two separate cohorts (cohort 1 n=384 patients, cohort 2 n=180 patients) of patients with chronic primary and secondary AI under standard replacement therapy and compared them to two age- and sex-matched population-based studies (SHIP-TREND/DEGS). Odds ratios with 95% CI for hypertension, hyperlipidemia/HLP, type 2 diabetes/T2DM, obesity, and hospitalization with adjustment for confounders were evaluated by logistic regression. Patient cohort 1 had significantly lower ORs for obesity [0.4 (0.3–0.6), p<0.001] and hypertension [0.5 (0.3–0.6), p<0.001] compared to SHIP-TREND and for obesity [0.7 (0.5–0.9), p=0.01], hypertension [0.4 (0.3–0.5), p<0.001] and HLP [0.4 (0.3–0.6), p<0.001] compared to DEGS. In cohort 2, ORs were significantly lower for HLP compared to both SHIP-TREND [0.4 (0.2–0.7), p=0.001] and DEGS [0.3 (0.2–0.5), p<0.001] and for hypertension [0.7 (0.4–0.9), p=0.04] compared to SHIP-TREND. In patients with SAI from cohort 2, ORs for DM2 [2.5 (1.3–4.9) p=0.009], hypertension [2.5 (1.4–4.5), p=0.002] and obesity [1.9 (1.1–3.1), p=0.02] were significantly higher compared to DEGS, whereas ORs for HLP were significantly lower compared to both SHIP [0.3 (0.1–0.6), p=0.002] and DEGS [0.3 (0.1–0.6), p<0.001]. In most of our AI patients treated with conventional glucocorticoid doses, the risk for T2DM, obesity, hypertension, and HLP was not increased. The number of hospitalizations was significantly higher in AI patients compared to controls, which might reflect increased susceptibility but also a more proactive management of concomitant diseases by physicians and patients.

Key words

adrenal insufficiency - hyperlipidaemia - hypertension - obesity, metabolic syndrome - cardiovascular risk factors - hospitalization

Supplementary Material



Publication History

Received: 12 July 2023

Accepted after revision: 11 October 2023

Accepted Manuscript online:
12 October 2023

Article published online:
03 January 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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