Adrenal Insufficiency Hospitalizations Associated With Psychosocial Factors

Psychosocial factors are associated with adrenal insufficiency hospital admissions among women aged between 20 and 29 years, according to research findings published in Frontiers in Endocrinology.

Adrenal insufficiency requires a high level of self-management by patients to prevent the development of an adrenal crisis. Although previous study findings support psychological stress as a cause of adrenal crises, the unexplained spike in hospitalizations for adrenal crises, especially among young women, warrants a more thorough evaluation.

To further understand the association between personal and social factors and adrenal insufficiency-related hospitalizations, researchers in New South Wales, Australia conducted a population-based study using hospital admission data from the Admitted Patient Data Collection. Patients were adults aged from 20 to 29 years with primary or comorbid adrenal insufficiency.

Eligible diagnostic codes included primary adrenal insufficiency, adrenal crisis, hypopituitarism, drug-induced hypopituitarism, adrenal insufficiency, and congenital adrenal hyperplasia. Exclusion criteria were admissions related to trauma, major surgery, obstetric and gynecological indications, or a principal diagnosis of a psychiatric illness.

The researchers calculated mean admission rates using age-sex specific populations from national repositories for each year of the study duration. Relevant psychosocial factors included psychiatric diagnoses, employment and unemployment, housing and economic circumstances, social environment, family circumstances, psychosocial circumstances, lifestyle, and care provider dependency.

The study population consisted of 877 adult patients (64.9% women). Among these patients, the admission rates were 22% (adrenal crisis), 32.3% (primary adrenal insufficiency), 45.0% (secondary adrenal insufficiency), and 4.9% (congenital adrenal hyperplasia). 

The average admission rate was almost twice as high among women (63.5 million per year; SD, 38.0) compared with men (34.0 million per year; SD, 13.4; P <.01). Women also constituted the majority of adrenal crisis admissions (67.9%), as average adrenal crisis admission rates were 14.7 million per year (SD, 12.3) among women and 6.75 million per year (SD, 3.77) among men.

Across the study duration, the 3-year moving average rate increased by 298.0% among women and by 68.2% among men (P <.001). Adrenal crisis-related 3-year moving rates also increased by a greater extent among women (199.29%) compared with men (65.1%).

Common comorbid conditions upon admission included type 1 diabetes (12.2%), type 2 diabetes (6.5%), major psychiatric disorders (5.9%), alcohol/drug use (4.6%). However, only type 1 diabetes was significantly associated with adrenal crises among women only (P <.05).

The researchers found a comorbid diagnosis of at least 1 psychosocial problem among 22.1% of admissions. Compared with men, women had a greater proportion of admissions with a diagnosis of a psychosocial problem (26.0% vs 14.9%). Among women, at least 1 psychosocial problem was associated with an adrenal crisis (P <.001)) and signs of an adrenal crisis (P <.001).

Admissions associated with at least 1 psychosocial factor increased over the study period from 5.8 to 33.4 per million (P <.001) but remained consistent among men. Changes in psychosocial score rates also correlated with adrenal insufficiency (r=0.98; P <.001) and adrenal crisis admission rates (r=0.82; P <.001) among women but not among men.

Study limitations include adrenal crisis definition variability within the dataset, the potential for repeat admissions due to unmatched patient data, and the presence of confounding factors due to the inherent nature of the study design.

According to the researchers, “By placing self-management of [adrenal insufficiency] into the wider context of social and personal factors which influence the health and wellbeing of patients, this study suggests that there are inevitable limitations of an approach to patient care in which education is provided without additional support for patients with vulnerabilities.”