ESA-SRB-AOTA 2019

The incidence of adrenal insufficiency in hospitalised patients with primary and secondary adrenal malignancies: An analysis of hospital admission data, NSW, 2006-2017 (#518)

Anna J Lubomski 1 , Henrik Falhammar 2 , David J Torpy 3 4 , Louise Rushworth 1
  1. School of Medicine, University of Notre Dame Australia, Sydney, NSW, Australia
  2. Endocrine and Metabolic Unit, Royal Adelaide Hospital and University of Adelaide, Adelaide, SA, Australia
  3. Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm , Sweden
  4. Menzies School of Health Research and Royal Darwin Hospital, Tiwi, NT, Australia

Background:

Adrenal metastases (AM) are common in patients with metastatic malignant disease. Bilateral AMs may cause adrenal insufficiency (AI) and affected patients are at risk of an adrenal crisis (AC). Symptoms of AI are similar to those of advanced malignancy, and the incidence of AI/AC metastatic malignancy is uncertain.

Methods:

This retrospective study evaluated data on all admissions to NSW hospitals between 2006 and 2017 from the NSW Ministry of Health Admitted Patient Data Collection (APDC). Patient demographics, their primary malignancies, a principal or comorbid diagnosis of AI, and the incidence of a diagnosed AC were assessed.

Results:

There was a total of 14,665 hospital admissions with a principal or comorbid diagnosis of AM in NSW over the study period, corresponding to 1222.1 admissions/year. The majority (62.0%, n=9094) of patients were male. The mean patient age was 67.2 (+/-12.1) years. The most common primary malignancies were: lung 50.5% (n=7403), melanoma 8.7% (n=1276), kidney 6.7% (n=987), and breast 4.7% (n=689). A principal or comorbid diagnosis of AI was recorded in 162 patients (1.1% of all admissions) and 19 (11.7% of AI diagnoses, 0.1% of all admissions) of these were classified as an AC. An AC was more common in men (89.5%, n=17, p<0.05), while there was no difference between the sexes in the incidence of AI.  Four patients (21%) with an AC died during the admission.    

Conclusion:

AI, due to AM can be managed by glucocorticoid replacement therapy, arises in only in a small proportion of patients with AM and can be associated with an AC. AI due to other causes may also occur. The results of this study support an approach to management of AM patients that aims to detect and manage AI based on early evaluation of indicative AI symptoms rather than systematic screening of asymptomatic patients.