This Article Full Text Full Text (PDF) All Versions of this Article: 91/12/4849    most recent Author Manuscript (PDF) Submit a related Letter to the Editor Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Copyright Permission Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Bergthorsdottir, R. Articles by Johannsson, G. Search for Related Content PubMed PubMed Citation Articles by Bergthorsdottir, R. Articles by Johannsson, G. Related Collections Adrenal and Hypertension

Premature Mortality in Patients with Addison’s Disease: A Population-Based Study

Department of Endocrinology (R.B., M.L.-Z., G.J.), Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden; and Department of Mathematical Sciences (A.O.), Chalmers University of Technology, SE-412 96 Gothenburg, Sweden

Address all correspondence and requests for reprints to: Ragnhildur Bergthorsdottir, M.D., Department of Endocrinology, gr str 8, Sahlgrenska University Hospital, SE-413 45 Göteborg, Sweden. E-mail: Ragnhildur.Bergthorsdottir{at}medic.gu.se.

Background: The survival rate of patients with primary adrenal insufficiency (Addison’s disease) undergoing currently accepted replacement therapy is not known, although well-informed patients are considered to have a normal survival rate. In this study, we evaluated the mortality of patients with Addison’s disease in Sweden.

Methods: A population-based, retrospective, observational study was performed, using the National Swedish Hospital and Cause of Death Registers, covering the period from 1987–2001. After a diagnosis of Addison’s disease, each patient was followed until the end of follow-up or death. Mortality was compared with that of the Swedish background population.

Findings: We identified 1675 patients (995 women and 680 men) diagnosed with primary adrenal insufficiency. The average follow-up from initial diagnosis was 6.5 yr. Five hundred seven patients died during the study period compared with an expected 199. The risk ratio for all-cause mortality was 2.19 (confidence interval 1.91–2.51) for men and 2.86 (confidence interval 2.54–3.20) for women. The excess mortality in both men and women was attributed to cardiovascular, malignant, and infectious diseases. Concomitant diabetes mellitus was observed in 12% of the patients, but only contributed to the increased mortality to a minor extent.

Interpretation: Compared with the background population, we observed that the risk ratio for death was more than 2-fold higher in patients with Addison’s disease. Cardiovascular, malignant, and infectious diseases were responsible for the higher mortality rate.

This article has been cited by other articles:

				B. R Walker Glucocorticoids and Cardiovascular Disease Eur. J. Endocrinol., November 1, 2007; 157(5): 545 - 559. [Abstract] [Full Text] [PDF]

				S. Hahner, M. Loeffler, M. Fassnacht, D. Weismann, A.-C. Koschker, M. Quinkler, O. Decker, W. Arlt, and B. Allolio Impaired Subjective Health Status in 256 Patients with Adrenal Insufficiency on Standard Therapy Based on Cross-Sectional Analysis J. Clin. Endocrinol. Metab., October 1, 2007; 92(10): 3912 - 3922. [Abstract] [Full Text] [PDF]

				P. Elfstrom, S. M. Montgomery, O. Kampe, A. Ekbom, and J. F. Ludvigsson Risk of Primary Adrenal Insufficiency in Patients with Celiac Disease J. Clin. Endocrinol. Metab., September 1, 2007; 92(9): 3595 - 3598. [Abstract] [Full Text] [PDF]