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.
Key words
adrenal insufficiency - adrenal crisis - glucocorticoid replacement - hydrocortisone
- cortisone acetate
