Longitudinal AddiQoL scores may identify higher risk for adrenal crises in Addison’s disease
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Several studies have shown a reduced quality of life (QoL) in patients with Addison’s disease (AD), but investigations of QoL over a long-term course are lacking. Adrenal crises (AC) are life-threatening complications in AD. The purpose of this prospective study was to test whether the repeated use of QoL-questionnaires can detect prodromal periods of an AC.
110 patients with AD were asked to complete the disease specific-QoL questionnaire AddiQoL and a short questionnaire about adverse events once monthly over a period of ten months. AC was defined if at least two of the following symptoms were reported: (a) hypotension, (b) nausea or vomiting, (c) severe fatigue, (d) documented hyponatremia, hyperkalemia, or hypoglycemia, and subsequent parenteral glucocorticoid administration was carried out.
Prevalence of AC was 10.9/100 patient years. AddiQoL scores in patients with AC showed a trend (p = 0,08) to a wider fluctuation over time. Subjective precrises not meeting the criteria for AC were reported by 31 patients who had significantly lower AddiQoL scores (p = 0,018).
These are the first data showing the course of QoL during a period of ten months in patients with AD. Incidence of AC exceeds previous data. Our data show, that subjective precrises in AD associate with lower QoL. AC, as well as precrises affect intraindividual AddiQol-scores over time with a trend to a stronger fluctuation. Longitudinal AddiQol scores and self-reporting of precrises via patient diaries are additional clinical tools to identify higher risk for critical events.
KeywordsAddison’s disease Adrenal insufficiency Adrenal crises AddiQoL
We thank Reinhard Santen (Endocrinological Group Practice, Centre for hormonal disorders and metabolic diseases, Frankfurt, Germany), Alexander Mann (Endokrinologikum Frankfurt am Main, Centre for Endocrinology and Metabolism, Rheumatology and Neurology, Germany), Michael Droste (Medicover, ambulatory healthcare centre, Oldenburg, Germany), Antje Spens (Ambulatory healthcare centre for metabolic diseases, Leipzig, Germany), Nina Krause and Martin Merkel (Endokrinologikum, ambulatory healthcare centre, Hannover, Germany) and the patient support group “Netzwerk“ for their support in recruitment of patients and acquisition of data. Special thanks to our study coordinator Maria Sandler. This study was supported by the European Union 7th framework Health programme FP7 with the acronym EURADRENAL under the grant agreement 2008-201167.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
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