Background
Patients with Addison’s disease (AD) and comorbid Type1 diabetes mellitus (T1DM) are at increased risk of acute metabolic disorders relative to patients with a single condition. The reasons for this are unknown.
Methods
All attendances for a medical illness by AD patients at the emergency department of a Sydney hospital between 2000 and 2017 were reviewed. Physiological parameters and illness management strategies were compared between AD patients, those with T1DM and AD combined, and a control group of patients with T1DM who were matched to the diabetic AD patients by age and sex.
Results
Of the 46 AD hospital attendances for acute medical problems, six (13.0%) were due to missed medication/non-compliance/acute alcohol intoxication and one to excessive exercise. The remaining 39 presentations represented 20 AD (28 attendances) and 5 AD/T1DM patients (11 presentations). There were 17 (43.6%) diagnosed adrenal crises (63.6% (n=7) in AD/T1DM and 35.7% (n=10) in AD only) and stress doses preceded 61.5% (n=24) attendances. Four patients used intramuscular hydrocortisone. Patients who used stress doses had a history of more presentations than those who did not (2.0+/-1.3 vs 1.2+/-0.5, p=0.01). AD/T1DM patients had more hypoglycaemia (27.3% vs 0%, p<0.05); fever 54.5% vs 14.3%, p<0.05; and infection (63.6% vs 46.4%, p=ns). There were 40 presentations for 11 T1DM control patients, none with diabetic ketoacidosis. More control patients had hyperglycaemia (62.5% vs 18.2%, p<0.01) and fewer had hypoglycaemia (10.0% vs 27.3%, p=NS) than diabetic AD patients.
Conclusion
Patients with AD develop acute illness due to a range of issues, including medication non-adherence and psychosocial factors. More prior hospital presentations increased stress dose use. Patients with combined disease had 7/11 presentations with an AC diagnosis. They also had a higher incidence of hypoglycaemia than AD only patients and a lower incidence of hyperglycaemia than T1DM control patients.