Background: There is mounting evidence that current replacement regimens fail to fully restore health-related subjective health status in patients with adrenal insufficiency (AI). Here we evaluated the subjective health status (SHS) 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 co-morbidities were verified by review of medical records. Patients were asked to complete three validated self-assessment questionnaires (SF-36, GBB-24, 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 out of eight SF-36 dimensions, all five GBB-24 scales and the HADS anxiety score reflected significant impairment of SHS in both AI cohorts (all p<0.001). Even after exclusion of all patients with any concomitant disease SHS 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). 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 physiologic glucocorticoid replacement strategies in AI will ameliorate these impairments.