Study of Adrenal Crises in Adults With Adrenal Insufficiency
There were 824 hospital admissions during the study period in which an AC was recorded, corresponding to an overall rate of 74.9 admissions per year. The median age of patients was 61 years and there were more female (62.5%) than male patients (37.5%), (Table 1). The number of admissions increased with age up to the 70–79 year age group (Table 1). Over half (52.8%) the admissions with an AC were in the age category of 60 years and over. By comparison, only 26.9% of the comparable NSW population was aged 60 years or more (Table 1). Other demographic features of this patient group are outlined in Table 1.
In 467 (56.7%) of the admissions, the patient's principal diagnosis was an AC and 61 patients (7.4%) had an AC recorded as their only diagnosis. The proportion of admissions in which the principal diagnosis was an AC decreased with age, from over 68% in the youngest three age groups to 60.5% in the 50–59 year group, 56.2% in the 60–69 year group, 41.5% in the 70–79 year group and 43.1% in those patients aged 80 and above. An underlying cause of the AI was recorded in only 143 (17.4%) of the cases. There were 58 (7.0%) patients identified as having PAI and 48 (5.8%) with hypopituitarism and the remainder had other causes recorded (Table 2). Diabetes mellitus (DM) was reported in 178 (21.6%) of the patient admissions, 53 (6.4%) had Type 1 DM and a larger group of 125 (15.2%) had Type 2 DM. There were 26 (3.2%) deaths recorded for the whole patient group. However, among the 467 patients whose principal diagnosis was an AC, there were 4 (0.9%) deaths.
The average admission rate for the study group was 15.0 (95% CI, 8.4, 24.7) admissions/million/year. While patients in the younger age groups had lower rates than average, those aged 60–69 years had a rate of 24.3 admissions/million/year, patients in the 70–79 year age group had a higher rate (35.2 admissions/million/year) and those patients age 80 years and over had the highest rate of 45.8 admissions/million/year. The average AC admission rates for each age group, together with the corresponding 95% CIs, are shown in Table 1. Poisson regression analysis demonstrated that the age group of the patient was significantly associated with the number of AC admissions (Wald Chi sq (6) =619.3, p < 0.0001).
An infection was identified in either the principal or a secondary diagnosis field in 317 (38.5%) of patient admissions (Table 2). A record of infection was significantly associated with the age group of the patient (Chi sq (6) = 41.5, p < 0.0001) (Figure 1). One fifth (20.7%) of the patients in the youngest age group (20–29 years) were recorded as having an infection compared with 49.7% of the 70–79 years group and 55.3% of the oldest (80 and over) age group. Infections, which were recorded as bacterial in origin, were significantly more common in the study group than were infections due to viruses (131 (15.9%) and 61 (7.4%) respectively, z = 5.4, p < 0.01). Viral infections were not significantly associated with the age or sex of the patient. By comparison, bacterial infections were significantly associated with age (Chi sq (6) = 33.5, p < 0.0001) (Figure 1). Patients in the youngest age categories had the lowest levels of bacterial infection recorded (6.9% and 8.2% in the 20–29 and 30–39 year age groups respectively). In contrast, the group with the highest proportion of patients with a bacterial infection was the "80 and over" category, with 28.5% of the patients having a bacterial infection identified (Figure 1).
(Enlarge Image)
Figure 1.
Adrenal Crisis Admissions in NSW, 2000/1–2010/11. Percentage with Any Infection, Virus or Bacterium by Age Group.
There were 125 cases (15.2%) of gastroenteritis identified and of these only 27 (21.6%) were classified as being viral in origin. There was no significant association between the age and sex of the patient and the incidence of gastroenteritis. By comparison, pneumonia/LRTI was recorded in 85 (10.3%) of the patients. The proportion of patients with a pneumonia/LRTI was significantly associated with the age group (Chi sq (6) =37.9, p < 0.0001) but not the sex of the patient (Figure 2). As this figure demonstrates, the proportion of patients with a pneumonia/LRTI rose with increasing age and was highest among patients aged 80 years or more, where there were 26 patients (21.1%) with pneumonia.
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Figure 2.
Adrenal Crisis Admissions in NSW, 2000/1–2010/11. Percentage with Pneumonia/LRTI and UTI by Age and Sex.
There were 82 admissions (10.0%) in which a UTI was identified. Of these, 64 (78.0%) were in women. As Figure 2 shows, the proportion of admissions with a UTI increased substantially with the age of the patient. Over one fifth of the women in both the 70–79 year age group (24.4%) and the 80 years and over age group (21.7%) had a UTI in association with the AC (Figure 3).
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Figure 3.
Adrenal Crisis Admissions in NSW, 2000/1–2010/11. Percentage with UTI by Age and Sex.
Results
There were 824 hospital admissions during the study period in which an AC was recorded, corresponding to an overall rate of 74.9 admissions per year. The median age of patients was 61 years and there were more female (62.5%) than male patients (37.5%), (Table 1). The number of admissions increased with age up to the 70–79 year age group (Table 1). Over half (52.8%) the admissions with an AC were in the age category of 60 years and over. By comparison, only 26.9% of the comparable NSW population was aged 60 years or more (Table 1). Other demographic features of this patient group are outlined in Table 1.
In 467 (56.7%) of the admissions, the patient's principal diagnosis was an AC and 61 patients (7.4%) had an AC recorded as their only diagnosis. The proportion of admissions in which the principal diagnosis was an AC decreased with age, from over 68% in the youngest three age groups to 60.5% in the 50–59 year group, 56.2% in the 60–69 year group, 41.5% in the 70–79 year group and 43.1% in those patients aged 80 and above. An underlying cause of the AI was recorded in only 143 (17.4%) of the cases. There were 58 (7.0%) patients identified as having PAI and 48 (5.8%) with hypopituitarism and the remainder had other causes recorded (Table 2). Diabetes mellitus (DM) was reported in 178 (21.6%) of the patient admissions, 53 (6.4%) had Type 1 DM and a larger group of 125 (15.2%) had Type 2 DM. There were 26 (3.2%) deaths recorded for the whole patient group. However, among the 467 patients whose principal diagnosis was an AC, there were 4 (0.9%) deaths.
The average admission rate for the study group was 15.0 (95% CI, 8.4, 24.7) admissions/million/year. While patients in the younger age groups had lower rates than average, those aged 60–69 years had a rate of 24.3 admissions/million/year, patients in the 70–79 year age group had a higher rate (35.2 admissions/million/year) and those patients age 80 years and over had the highest rate of 45.8 admissions/million/year. The average AC admission rates for each age group, together with the corresponding 95% CIs, are shown in Table 1. Poisson regression analysis demonstrated that the age group of the patient was significantly associated with the number of AC admissions (Wald Chi sq (6) =619.3, p < 0.0001).
An infection was identified in either the principal or a secondary diagnosis field in 317 (38.5%) of patient admissions (Table 2). A record of infection was significantly associated with the age group of the patient (Chi sq (6) = 41.5, p < 0.0001) (Figure 1). One fifth (20.7%) of the patients in the youngest age group (20–29 years) were recorded as having an infection compared with 49.7% of the 70–79 years group and 55.3% of the oldest (80 and over) age group. Infections, which were recorded as bacterial in origin, were significantly more common in the study group than were infections due to viruses (131 (15.9%) and 61 (7.4%) respectively, z = 5.4, p < 0.01). Viral infections were not significantly associated with the age or sex of the patient. By comparison, bacterial infections were significantly associated with age (Chi sq (6) = 33.5, p < 0.0001) (Figure 1). Patients in the youngest age categories had the lowest levels of bacterial infection recorded (6.9% and 8.2% in the 20–29 and 30–39 year age groups respectively). In contrast, the group with the highest proportion of patients with a bacterial infection was the "80 and over" category, with 28.5% of the patients having a bacterial infection identified (Figure 1).
(Enlarge Image)
Figure 1.
Adrenal Crisis Admissions in NSW, 2000/1–2010/11. Percentage with Any Infection, Virus or Bacterium by Age Group.
There were 125 cases (15.2%) of gastroenteritis identified and of these only 27 (21.6%) were classified as being viral in origin. There was no significant association between the age and sex of the patient and the incidence of gastroenteritis. By comparison, pneumonia/LRTI was recorded in 85 (10.3%) of the patients. The proportion of patients with a pneumonia/LRTI was significantly associated with the age group (Chi sq (6) =37.9, p < 0.0001) but not the sex of the patient (Figure 2). As this figure demonstrates, the proportion of patients with a pneumonia/LRTI rose with increasing age and was highest among patients aged 80 years or more, where there were 26 patients (21.1%) with pneumonia.
(Enlarge Image)
Figure 2.
Adrenal Crisis Admissions in NSW, 2000/1–2010/11. Percentage with Pneumonia/LRTI and UTI by Age and Sex.
There were 82 admissions (10.0%) in which a UTI was identified. Of these, 64 (78.0%) were in women. As Figure 2 shows, the proportion of admissions with a UTI increased substantially with the age of the patient. Over one fifth of the women in both the 70–79 year age group (24.4%) and the 80 years and over age group (21.7%) had a UTI in association with the AC (Figure 3).
(Enlarge Image)
Figure 3.
Adrenal Crisis Admissions in NSW, 2000/1–2010/11. Percentage with UTI by Age and Sex.
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