Horm Metab Res 2015; 47(09): 637-642
DOI: 10.1055/s-0035-1548869
Kategorie: Endocrine Care
© Georg Thieme Verlag KG Stuttgart · New York

Modern Hydrocortisone Replacement Regimens in Adrenal Insufficiency Patients and the Risk of Adrenal Crisis

R. L. Rushworth
1  School of Medicine, Sydney, The University of Notre Dame, Australia, Darlinghurst, Australia
,
D. J. Torpy
2  Endocrine and Metabolic Unit, Royal Adelaide Hospital and University of Adelaide North Terrace, Adelaide, Australia
› Author Affiliations
Further Information

Publication History

received 19 November 2014

accepted 13 March 2015

Publication Date:
07 May 2015 (eFirst)

Abstract

The aim of this study was to examine the incidence of adrenal crises (AC) and the prescription of short-acting glucocorticoids (GC) in different geographic areas. To do this we conducted a descriptive study of AC hospitalisations and prescriptions for two GCs (hydrocortisone (HC) and cortisone acetate (CA)), and fludrocortisone acetate (FA), in different geographic areas of Australia between 1999/2000 and 2011/2012, using government databases.

There were 2 584 hospital admissions for AC in Australia between 1999/00 and 2011/12 and the corresponding admission rates increased significantly from 7.4 to 11.1/106/year (p<0.001). AC admission rates increased in 5 out of 6 geographic areas. Prescription rates for the combined GCs (HC/CA) increased at an annual rate of between 0.2–2.0% in all areas. All areas had significant (p<0.01) increases in HC prescription rates (4.5% to 13.7% annually) and CA prescription rates decreased in 5 out of the 6 regions (3.5% annual decrease to a 0.5% annual increase). When the geographic areas were combined, there was a significant correlation between the AC admission rates and HC/CA prescription rates (r=0.30, p<0.01). Admissions for AC and GC prescriptions increased significantly in Australia after 1999 and these varied significantly by geographic area. These results suggest that modern recommendations for lower dose, short-acting GC replacement may be of concern and further investigation is warranted.