Imperial College London
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ProfessorNickOliver

Faculty of Medicine, Department of Metabolism, Digestion and Reproduction

Wynn Chair in Human Metabolism (Clinical)
 
 
 
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Contact

 

+44 (0)20 7594 1796nick.oliver

 
 
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Location

 

7S7aCommonwealth BuildingHammersmith Campus

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Summary

 

Publications

Citation

BibTex format

@article{Ngaosuwan:2021:clinem/dgab096,
author = {Ngaosuwan, K and Johnston, DG and Godsland, IF and Cox, J and Majeed, A and Quint, JK and Oliver, N and Robinson, S},
doi = {clinem/dgab096},
journal = {Journal of Clinical Endocrinology and Metabolism},
pages = {e2759--e2768},
title = {Increased mortality risk in patients with primary and secondary adrenal insufficiency},
url = {http://dx.doi.org/10.1210/clinem/dgab096},
volume = {106},
year = {2021}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - CONTEXT: Mortality data in patients with adrenal insufficiency are inconsistent, possibly due to temporal and geographical differences between patients and their reference populations. OBJECTIVE: To compare mortality risk and causes of death in adrenal insufficiency with an individually-matched reference population. DESIGN: Retrospective cohort study. SETTING: UK general practitioner database (CPRD). PARTICIPANTS: 6821 patients with adrenal insufficiency (primary, 2052; secondary, 3948) and 67564 individually-matched controls (primary, 20366; secondary, 39134). MAIN OUTCOME MEASURES: All-cause and cause-specific mortality; hospital admission from adrenal crisis. RESULTS: With follow-up of 40799 and 406899 person-years for patients and controls respectively, the hazard ratio (HR; [95%CI]) for all-cause mortality was 1.68 [1.58 - 1.77]. HRs were greater in primary (1.83 [1.66 - 2.02]) than in secondary (1.52 [1.40 - 1.64]) disease; (HR; primary versus secondary disease, 1.16 [1.03 - 1.30]). The leading cause of death was cardiovascular disease (HR 1.54 [1.32-1.80]), along with malignant neoplasms and respiratory disease. Deaths from infection were also relatively high (HR 4.00 [2.15 - 7.46]). Adrenal crisis contributed to 10% of all deaths. In the first two years following diagnosis, the patients' mortality rate and hospitalisation from adrenal crisis were higher than in later years. CONCLUSION: Mortality was increased in adrenal insufficiency, especially primary, even with individual matching and was observed early in the disease course. Cardiovascular disease was the major cause but mortality from infection was also high. Adrenal crisis was a common contributor. Early education for prompt treatment of infections and avoidance of adrenal crisis hold potential to reduce mortality.
AU  - Ngaosuwan,K
AU  - Johnston,DG
AU  - Godsland,IF
AU  - Cox,J
AU  - Majeed,A
AU  - Quint,JK
AU  - Oliver,N
AU  - Robinson,S
DO  - clinem/dgab096
EP  - 2768
PY  - 2021///
SN  - 0021-972X
SP  - 2759
TI  - Increased mortality risk in patients with primary and secondary adrenal insufficiency
T2  - Journal of Clinical Endocrinology and Metabolism
UR  - http://dx.doi.org/10.1210/clinem/dgab096
UR  - https://www.ncbi.nlm.nih.gov/pubmed/33596308
UR  - https://academic.oup.com/jcem/article/106/7/e2759/6141434
UR  - http://hdl.handle.net/10044/1/87816
VL  - 106
ER  -
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