SAT-384 The Health Burden of Adrenal Insufficiency in a United Kingdom-based Population

Context: Adrenal insufficiency (AI) is associated with reduced life expectancy and increased morbidity even after glucocorticoid replacement therapy. Aim Our aim was to assess the co-morbid burden of AI in a United Kingdom-based population. Methods We retrospectively studied patients diagnosed between 1996 and 2014 (minimum disease duration 12 months) with primary (PAI; n=55 [23 females]; CAH excluded) and secondary AI (SAI; n=79 [29 females]; Cushing’s syndrome and acromegaly excluded) using an electronic patient database (n=352000) in North West England. Patients with AI were identified by diagnostic codes and glucocorticoid prescriptions. Each patient with PAI or SAI was matched to non-AI patients with the same gender and date of birth (control cohort n=35172). Outcome measures were change in weight, prevalence of co-morbid illness (type 2 diabetes [T2D], prediabetes, hypertension, cardiovascular disease [CVD] and osteoporosis) and hospital admissions during the study period. Results In PAI, 91% of patients were treated with hydrocortisone (mean dose 23 ±8 mg) and 9% with prednisolone (mean dose 3 ±2 mg). In SAI, 94% of patients were treated with hydrocortisone (mean dose 18 ±8 mg) and 5% with prednisolone (mean dose 6 ±3 mg). The annual weight change compared to controls was significantly higher in PAI (median 1.16 kg [0.15-2.96], vs -0.01 kg [-0.49 – 0.41]; P=0.001) and SAI (median 0.55 kg [-1.49 – 1.57] vs median -0.47 kg [-0.99 – 0.32]; P=0.045). When comparing the weight at the time of diagnosis to the last available weight in the study period, a higher proportion of patients were within the overweight/obese category (BMI ≥ 25 kg/m(2)) for PAI (38% [baseline] vs 70% [study end]; P=0.028) but not SAI (85% [baseline] vs 73% [study end]; P=0.327) and controls (65% [baseline] vs 56% [study end]; P=0.218). For PAI, the prevalence of prediabetes (22% vs 10%), T2D (9% vs 5%), hypertension (38% vs 30%) and CVD (9% vs 5%) was significantly (p<0.05) different to controls. For SAI, the prevalence of prediabetes (27% vs 19%), T2D (20% vs 10%), hypertension (68% vs 53%) was significantly different (P<0.05) to controls. There were no differences in the prevalence of CVD between patients with SAI and controls (10% vs 10%; P=0.87). The risk ratio for osteoporosis to controls was 4.00 (P=0.025) for PAI and 4.33 (P=0.018) for SAI. The ratio (to controls) of the number of acute hospital admissions was higher in both PAI (5:1; P=0.011) and SAI (7:1; P=0.017). Conclusion PAI and SAI are both associated with a higher prevalence of co-morbid disease and increased hospital admissions suggesting a greater health burden. The excessive glucocorticoid replacement dose (especially in PAI) may have influenced the adverse metabolic changes observed. Statement of Support ViroPharma, now part of Shire, Lexington, MA, USA provided financial support but were not involved in the study design or interpretation of the data.