Category: Adrenal Disorders
Objective : We initiated a research retrospectively on those who had accurate diagnosis of adrenal insufficiency (AI) according to their cortisol levels after synacthen test. We aimed to elucidate the risk on hospitalization and mortality in subjects with AI.
AI will be confirmed if the plasma cortisol level is less than 18.5 ug/dL during 60 minutes after synacthen intravenous stimulation tests performed between January 1st, 2011 and December 31th, 2015 in a single tertiary medical center . We retrospectively analyzed the prognostic factors regarding primary outcome of hospitalization rate and secondary outcome of mortality.
Results : A total of 202 subjects received synacthen test consecutively from January 1st, 2011 to December 31th, 2015. The mean follow up was 34.5 months. Among them, 50.5% (102/202) were diagnosed as adrenal insufficiency, 49.5% have normal cortisol response during synacthen test (control group). The two groups had similar baseline characteristics, except the AI group had older age (62.8±17.0 vs 52.0±20.5 years, p<0.01), and higher prevalence of diabetes mellitus (DM) (22.5% vs 11%, p=0.03) than the control group. The Kaplan-Meier survival curve for disease-free events showed that AI group had a significant higher hospitalization rate. In unadjusted model, primary outcome of hospitalization rate is significant higher in the AI group than the control group (48% vs 31%, p=0.013), death occurred in 9 out of 102 (8.8%) patients in the AI group and 3 out of 100 (3%) in the control group with borderline significance (p=0.08). In the cox regression model, after adjusting DM comorbidities, AI had a significant independent HR of 1.63 (95% confidence interval: 1.03-2.57, p=0.037) for hospitalization than the control group.
This study showed that AI diagnosed by synacthen test had higher hospitalization rate than the normal cortisol response group. By the report of the NHANS data in USA, it also showed that patients with AI had higher admission rate along with increased mortality up to 2 times than non-AI population. However, most of the study designs were based on International Classification of Disease diagnosis codes rather than the plasma cortisol level of patients after synacthen injection.
Conclusion : Synacthen tests identified subjects with diagnosis of AI who had higher hospitalization rate than the normal cortisol response individuals.
Taipei Veterans General Hospital
Dr. Yi-Chun Lin was born in Taiwan and recieved medical degree from National Yang-Ming University. She completed full training course in medicine and enocirnolgy & metabolism in Taipei Veterans General Hospital. Now she works as an attending physician in Taipei Veterans General Hospital.