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Impaired Subjective Health Status in 256 Patients with Adrenal Insufficiency on Standard Therapy Based on Cross-Sectional Analysis

Endocrinology and Diabetes Unit (S.H., M.L., M.F., D.W., A.-C.K., B.A.), Department of Medicine I, University of Wuerzburg, 97080 Wuerzburg, Germany; Clinical Endocrinology, (M.Q.), Department of Medicine, Gastroenterology, Hepatology and Endocrinology, Charité Campus Mitte, Charité University Medicine Berlin, 10117 Berlin, Germany; Department of Psychotherapy and Psychosomatic Medicine (O.D.), University Hospital Leipzig, 04103 Leipzig, Germany; and Division of Medical Sciences (W.A.), University of Birmingham, Birmingham B29 7EX, United Kingdom

Address all correspondence and requests for reprints to: Prof. Dr. Bruno Allolio, M.D., Endocrinology and Diabetes Unit, Department of Medicine I, University of Wuerzburg, Josef-Schneider-Strasse 2, D-97080 Wuerzburg, Germany. E-mail: allolio_b{at}medizin.uni-wuerzburg.de.

Background: There is mounting evidence that current replacement regimens fail to restore health-related subjective health status fully in patients with adrenal insufficiency (AI). Here we evaluated the subjective health status in primary and secondary AI and the effect of concomitant disease.

Methods: In a cross-sectional study, all AI patients registered with the University Hospital Wuerzburg (n = 148) or with the German Self-Help Network (n = 200) were contacted by mail. Underlying diagnoses and comorbidities were verified by review of medical records. Patients were asked to complete three validated self-assessment questionnaires [Short Form 36 (SF-36), Giessen Complaint List (GBB-24), Hospital Anxiety and Depression Scale (HADS)]. Results were compared to sex- and age-matched controls drawn from the questionnaire-specific reference cohorts.

Results: We identified 348 patients, and 256 agreed to participate. Completed questionnaire sets were available from 210 patients [primary AI (n = 132), secondary AI (n = 78)]. Seven of eight SF-36 dimensions, all five GBB-24 scales, and the HADS anxiety score reflected significant impairment of subjective health status in both AI cohorts (all P < 0.001). Even after exclusion of all patients with any concomitant disease, subjective health status remained significantly impaired in five SF-36 subscales and four GBB-24 subscales. Secondary AI patients were slightly more compromised than primary AI, significant with regard to two SF-36 scales (P < 0.05) and the HADS depression score (P < 0.001). A total of 18.3% of the AI patients were out of work, compared to 4.1% in the general population.

Conclusion: Patients with AI on current standard replacement suffer from significantly impaired health-related subjective health status, irrespective of origin of disease or concomitant disease. Future studies will have to assess whether more physiological glucocorticoid replacement strategies in AI will ameliorate these impairments.

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